Abstract
Triple negative breast cancer is associated with aggressive behavior and high risk of local and regional failure. Aggressive surgical intervention is considered suitable. This makes role of breast conserving therapy (BCT) debatable in these patients. The objective of this study was to compare outcome of BCT for triple negative versus non-triple negative breast cancer. Medical records of patients who underwent breast conserving therapy from 1999 to 2009 at Shaukat Khanum Cancer Hospital and had complete receptor status information were extracted. Patients were divided into triple negative breast cancer (TNBC) and non-TNBC. Patient characteristics, medical treatment modalities and adverse events were compared. Expected five year locoregional recurrence free, disease free and overall survival was calculated. The Cox proportional hazard model was used to identify independent predictors of outcome. A total of 194 patients with TNBC and 443 with non-TNBC were compared. Significant difference was present for age at presentation (p<0.0001), family history (p=0.005), grade (p<0.0001) and use of hormonal therapy (p<0.0001). The number of locoregional failures, distant failures and mortalities were not significantly different. No significant difference was present in 5 year locoregional recurrence free (96% vs 92%, p=0.3), disease free (75% vs 74%, p=0.7) and overall survival (78% vs 83%, p=0.2). On multivariate analysis, tumor size, nodal involvement and hormonal treatment were independent predictors of negative events. Breast conserving therapy has comparable outcomes for triple negative and non-triple negative breast cancers.
Highlights
Gene expression profiling has shown that breast cancer is not a single disease but a spectrum of biological diversity (Lowery et al, 2012)
Expected 5 year locoregional recurrence free, disease free and overall survival was comparable between triple negative breast cancer (TNBC) versus NonTNBC patients
A case for aggressive surgical management of TNBC is made due to an alleged elevated rate of locoregional and distant adverse events when compared with NonTNBC
Summary
Gene expression profiling has shown that breast cancer is not a single disease but a spectrum of biological diversity (Lowery et al, 2012). TNBC has been linked with an increased risk of local and distant recurrence and elevated rates of mortality within first five years of treatment; data regarding outcomes of BCT in TNBC remain conflicting (Haffty et al, 2006; Dent et al, 2007; Nguyen et al, 2008). In the cohort of BCT, the triple negative subtype increased the risk of both locoregional and distant relapse in comparison with Non-TNBC (RR 1.88, 95%CI 1.58-2.22; RR 2.12, 95%CI 1.72-2.62) (Wang et al, 2013). This makes role of breast conserving therapy (BCT) debatable in these patients. The objective of this study was to compare outcome of BCT for triple negative versus non-triple negative breast cancer. Conclusions: Breast conserving therapy has comparable outcomes for triple negative and non-triple negative breast cancers
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