Triple-Negative Breast Cancer Is Associated With Higher Rate of Locoregional Recurrence for Patient Achieving Less Than a pCR Following Neoadjuvant Chemotherapy, Surgery, and Radiation Therapy

Abstract

interval with higher incidence of visceral metastasis including lung, liver, and brain. Few reports have suggested similar rates of loco-regional failure compared with receptor positive subtypes. We undertook this retrospective study to analyze the demographic characteristics and pattern of failures in TNBC breast cancer. Materials/Methods: Tumor registry queries identified 476 patients with TNBC diagnosed between 1996 and 2011. Demographic and clinical information including age, race, menopausal status, stage, insurance status and tumor characteristics were collected after obtaining IRB approval. Information regarding sites of failure was collected. The Kaplan-Meier method was used to compute local failure-free survival (LFFS) and distal failure-free survival (DFFS) probabilities with p values for group comparisons computed using the log-rank statistic. Fisher’s exact test was used to compare frequencies for categorical variables. Results: Fifty-eight percent of patients (nZ 275) were between 41 and 60 years, with 20% (n Z 93) and 23% (n Z 103) being 40 and > 61 years, respectively. Forty-nine percent (n Z 231) patients were white, 47% (n Z 223) were AA and 4% was others. Fifty-five percent (n Z 262) were premenopausal and 83% (n Z 396) had grade 3 tumors. Stage II (48%, n Z 230) was most frequent stage at diagnosis followed by stage III (28%, n Z 131), stage I (19%, n Z 91) and stage IV (5%, n Z 24). Twenty-eight percent (nZ 133) had lymphovascular invasion versus 65% with none and 7% not reported. Ninety-three percent of the patients received either neoadjuvant or adjuvant chemotherapy, 93% patients received surgery including mastectomy or lumpectomy and 73% was treated with radiation. The 2, 5, and 8-year Kaplan-Meier LFFS: DFFS was 77%:73%, 64%:62% and 58%:56%, respectively. Black and white patients did not differ statistically with respect to OS (p Z 0.38), LFFS (p Z 1.0), or DFFS (p Z 0.77). Sixty-five (14%) patients failed locally either with IBTR or CW, 20 (4%) failed in the regional lymphatics. Lung (n Z 83, 17%) was the most frequent distant failure site followed by liver in 50 (11%), brain in 53 (11%), and bone in 53 (11%). Fifty-nine patients (12%) failed in nonregional lymph nodes. Additionally, 22 (5%) patients failed in skin or soft tissue outside breast or chest wall. AA and white patients did not differ statistically with respect to failure sites. Conclusions: Survival and failure site outcomes for AA and white patients did not differ in this large series of TNBC cases. Lung is the predominate site of distant failure and few patients failed in the regional lymph nodes. Even beyond 5 years, the probability of failing locally or distally continues to occur steadily. Author Disclosure: S. Prasad: None. T.M. Zagar: None. S. James: None. P. Walker: None. R. Raab: None. J. Efird: None. T. Biswas: None.