Abstract
Triple negative breast cancers (TNBC) behave more aggressively than hormone-receptor positive breast cancers. They are also known preferentially to affect young black women, often leading to poorer outcomes compared with those for white women. We sought to evaluate the comprehensive patterns of failure associated with treatment for TNBC at an urban institution with a predominantly black population and to assess the impact of social determinants of health on treatment failure. A retrospective review of TNBC patients treated from 2005 to 2015 was conducted. Detailed patient, tumor, and treatment characteristics and information on patterns of failure were included. With a median follow-up of 46months, 32 (16%) documented failures occurred. Locoregional failures comprised 84% of failure patterns whether isolated or in combination with distant failure. Treatment failure was associated with insurance type and smoking status, as well as several tumor characteristics. On multivariate analysis, pathologic nodal staging was the most significant predictor of treatment failure. In contrast to previous studies, we found that black women had higher overall survival than white women, but race was not associated with differences in recurrence patterns or with likelihood of treatment failure. Regardless of race, of the patients who recurred, 53% failed in distant and locoregional sites simultaneously, with an additional 34% failing locally only. These results highlight the need for aggressive local therapies in high-risk patients and suggest a need for improved follow-up focusing on detecting locoregional failures. Multidisciplinary care is essential in the management of these patients at time of failure.
Highlights
We sought to evaluate the comprehensive patterns of failure associated with treatment for triple negative breast cancer (TNBC) at a single urban institution
Triple negative breast cancers (TNBC) account for approximately 12-17% of all breast cancers in the United States, and behave more aggressively than hormone-receptor positive breast cancers [1,2,3]. These tumors are negative for estrogen-receptor (ER), progesterone-receptor (PR) and human epidermal growth factor receptor 2 (HER-2) and tend to occur more commonly in black women and women
Patients were included if they had a diagnosis of invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC) with ER, PR and Her-2 receptor proven negative by immunohistochemistry (IHC) or fluorescence in-situ hybridization who received chemotherapy, surgery, and/or radiation therapy at our institution
Summary
We sought to evaluate the comprehensive patterns of failure associated with treatment for triple negative breast cancer (TNBC) at a single urban institution. Triple negative breast cancers (TNBC) account for approximately 12-17% of all breast cancers in the United States, and behave more aggressively than hormone-receptor positive breast cancers [1,2,3]. These tumors are negative for estrogen-receptor (ER), progesterone-receptor (PR) and human epidermal growth factor receptor 2 (HER-2) and tend to occur more commonly in black women and women
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