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Kadi MS, Alhebshi AH, Shabkah AA, Alzahrani WA, Enani GN, Samkari AA, Iskanderani O, Saleem AM, Farsi AH, Trabulsi NH. Histopathological Patterns and Outcomes of Triple-Positive Versus Triple-Negative Breast Cancer: A Retrospective Study at a Tertiary Cancer Center. Cureus 2023; 15:e42389. [PMID: 37621828 PMCID: PMC10446888 DOI: 10.7759/cureus.42389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Background One of the leading causes of cancer-related deaths in females under 45 years old is breast cancer (BC). The definition of triple-negative breast cancer (TNBC) is the lack of expression of estrogen receptors (ERs) as well as progesterone receptors (PRs) and Erb-B2 receptor tyrosine kinase 2 (HER2) gene amplification. Triple-positive breast cancer (TPBC), on the other hand, is defined as tumors expressing a high level of ER, PR, and HER2 receptors. This study aims to assess the phenotypes of TNBC and TPBC by comparing their individual clinical behavior patterns and prognosis throughout the course of the disease in a tertiary cancer center in the Kingdom of Saudi Arabia (KSA). Methods Our study is a retrospective study using electronic medical records (EMRs) to identify all female patients diagnosed with BC using the International Classification of Diseases-10 (ICD-10) codes (between C50 and C50.9). About 1209 cases with primary BC female patients were recognized based on histopathology reports. Further subclassification into TPBC and TNBC was performed. Statistical analysis was performed using Rv3.6.2 (R Studio, version 3.5.2, Boston, MA, USA). The descriptive data were presented as means and standard deviations (SD). Survival curves were approximated using the Kaplan-Meier method. The comparison between survival curves between both groups was achieved using the log-rank test. The multivariate model was constructed based on the identified predictors using univariate analysis. Results Univariate analysis of overall survival (OS) showed that mortality was higher in TNBC compared to TPBC (HR = 2.82, P-value <0.05). However, in a multivariate analysis, molecular subtypes did not show a significant effect on OS with a P-value of 0.94. We found that age at diagnosis has been associated with a 4% increase in mortality risk with a yearly rise in age. Conclusion In this limited retrospective cohort study, we found that TNBC may not be associated with a higher risk of death than TPBC. However, other factors, including age at diagnosis, surgical intervention, and lymphovascular invasion (LVI), have been observed to increase the risk of mortality. On the other hand, patients with TNBC were found to have a worse prognosis in terms of local recurrence. This information cannot be generalized to all patients with BC given the limitations of this study. Further, larger cohorts are needed to explore biological and treatment-related outcomes in patients with TNBC and TPBC.
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Affiliation(s)
- Mai S Kadi
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Alaa A Shabkah
- Department of Surgery, International Medical Center, Jeddah, SAU
| | - Walaa A Alzahrani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Ghada N Enani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Ali A Samkari
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Omar Iskanderani
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulaziz M Saleem
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Ali H Farsi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Nora H Trabulsi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Schmidt G, Gerlinger C, Juhasz-Böss I, Stickeler E, Rody A, Liedtke C, Wimberger P, Link T, Müller E, Fehm T, Abel M, Stein S, Bohle R, Endrikat J, Solomayer EF. Her2-neu score as a prognostic factor for outcome in patients with triple-negative breast cancer. J Cancer Res Clin Oncol 2016; 142:1369-76. [PMID: 27008006 DOI: 10.1007/s00432-016-2146-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/09/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Triple-negative breast cancer (TNBC) is characterized by a strong heterogeneity with regard to tumour biology as well as in the clinical course of the disease. This study aimed to analyse whether there are any prognostic factors enabling prediction of the clinical outcome in patients with TNBC. Particularly, the impact of Her2-neu score 0 versus Her2-neu score 1 and 2 on survival was investigated. MATERIALS AND METHODS We retrospectively studied a cohort of 1013 patients with TNBC, diagnosed at seven hospitals between May 2002 and February 2015. We studied the impact of Her2-neu scores (0 vs. 1 or 2 with negative FISH) on disease-free survival (DFS) and overall survival (OS). RESULTS 1013 patients were included in this study. 447 (44.13 %) of them had a T2-4 tumour. A total of 314 (31.00 %) were nodal-positive and 714 (70.48 %) had high-grade tumours. The Her2-neu score of all participating patients was determined. 588 (58.05 %) of them had a Her2-neu score 0, and 425 (41.95 %) had a score of 1 or 2. This study shows that TNBC patients with a Her2-neu score 0 had a significantly poorer outcome regarding DFS (p = 0.0001) and OS (p = 0.0051) compared to a score of 1 or 2. In contrast, grading did not seem to have any prognostic value for women with TNBC. CONCLUSION The Her2-neu score 0 might be considered as an innovative prognostic factor for patients with TNBC indicating poor clinical outcome.
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Affiliation(s)
- Gilda Schmidt
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, University of Saarland, 66421, Homburg, Germany.
| | - Christoph Gerlinger
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, University of Saarland, 66421, Homburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, University of Saarland, 66421, Homburg, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynaecology, RWTH Aachen University, 52062, Aachen, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538, Lübeck, Germany
| | - Cornelia Liedtke
- Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538, Lübeck, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Carl Gustav Carus University Hospital, 01069, Dresden, Germany
| | - Theresa Link
- Department of Gynecology and Obstetrics, Carl Gustav Carus University Hospital, 01069, Dresden, Germany
| | | | - Tanja Fehm
- Department of Gynecology and Obstetrics, Duesseldorf University Hospital, 40225, Düsseldorf, Germany
| | - Manuela Abel
- Hospital Idar-Oberstein, 55743, Idar-Oberstein, Germany
| | - Stefan Stein
- Hospital Idar-Oberstein, 55743, Idar-Oberstein, Germany
| | - Rainer Bohle
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, University of Saarland, 66421, Homburg, Germany
| | - Jan Endrikat
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, University of Saarland, 66421, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, University of Saarland, 66421, Homburg, Germany
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Eralp Y, Kılıç L, Alço G, Başaran G, Doğan M, Dinçol D, Demirci S, İçli F, Onur H, Saip P, Haydaroğlu A. The Outcome of Patients with Triple Negative Breast Cancer: The Turkish Oncology Group Experience. THE JOURNAL OF BREAST HEALTH 2014; 10:209-215. [PMID: 28331673 DOI: 10.5152/tjbh.2014.1904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 06/24/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Triple negative breast cancer (TNBC) is generally considered as a poorer prognostic subgroup, with propensity for earlier relapse and visceral involvement. The aim of this study is to evaluate the outcome of non-metastatic TNBC patients from different centers in Turkey and identify clinical and pathologic variables that may effect survival. MATERIALS AND METHODS Between 1993-2007, from five different centers in Turkey, 316 nonmetastatic triple negative breast cancer patients were identified with follow-up of at least 12 months. The data was collected retrospectively from patient charts. The prognostic impact of several clinical variables were evaluated by the Kaplan-Meier and Cox multivariate anayses. RESULTS Mean age at diagnosis was 49 years (range: 24-82). The majority of the patient group had invasive ductal carcinoma (n: 260, 82.3%) and stage II disease (n: 164; 51.9%). Majority of the patients (87.7%) received adjuvant chemotherapy. 5 year overall survival (OS) and disease-free survival (DFS) rates were 84.6% and 71.6%, respectively. Univariate analysis revealed locally advanced disease (p: 0.001), advanced pathological stage (p: 0.021), larger tumor size (T1&T2 vs T3&T4) (p<0.001), nodal positivity (p: 0.006), and extensive nodal involvement (p<0.001) as significant factors for DFS; whereas, advanced pathological stage (p: 0.017), extensive nodal involvement (p<0.001) and larger tumor size (p: 0,001) and presence of breast cancer-affected member in the family (p=0.05) were identified as prognostic factors with an impact on OS. Multivariate analysis revealed larger tumor size (T3&T4 vs T1&T2) and presence of lymph node metastases (node-positive vs node-negative) as significant independent prognostic factors for DFS (Hazard ratio (HR): 3.03, 95% CI: 1.71-5.35, p<0.001 and HR: 1.77, 95% CI: 1.05-3.0, p=0.03, respectively). Higher tumor stage was the only independent factor affecting overall survival (HR: 2.81; 95% CI, 1.27-6.22, p=0.01). CONCLUSION The outcome of patients with TNBC in this cohort is comparable to other studies including TNBC patients. Tumor size and presence of lymph node metastasis are the major independent factors that have effect on DFS, however higher tumor stage was the only negative prognostic factor for OS.
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Affiliation(s)
- Yeşim Eralp
- Department of Medical Oncology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Leyla Kılıç
- Department of Medical Oncology, Fırat University Hospital, Elazığ, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, İstanbul, Turkey
| | - Gül Başaran
- Department of Medical Oncology, Acibadem University Faculty of Medicine, İstanbul, Turkey
| | - Mutlu Doğan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Dilek Dinçol
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Senem Demirci
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Fikri İçli
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Handan Onur
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Pınar Saip
- Department of Medical Oncology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Ayfer Haydaroğlu
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
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Identification of prognostic different subgroups in triple negative breast cancer by Her2-neu protein expression. Arch Gynecol Obstet 2014; 290:1221-9. [DOI: 10.1007/s00404-014-3331-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/17/2014] [Indexed: 01/19/2023]
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Racial disparities in survival and age-related outcome in postsurgery breast cancer patients in a new york city community hospital. ISRN ONCOLOGY 2014; 2014:694591. [PMID: 24693452 PMCID: PMC3945176 DOI: 10.1155/2014/694591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/23/2013] [Indexed: 01/25/2023]
Abstract
Breast cancer survival has significantly improved over the past two decades. However, the diagnosis of breast cancer is lower and the mortality rate remains higher, in African American women (AA) compared to Caucasian-American women. The purpose of this investigation is to analyze postoperative events that may affect breast cancer survival. This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center cancer registry from 1997 to 2010. Of the 1538 patients in the registry, 1226 are AA and 269 are Caucasian. The study was divided into two time periods, 1997-2004 (period A) and 2005-2010 (period B), in order to assess the effect of treatment outcomes on survival. During period A, 5-year survival probabilities of 75.37%, 74.53%, and 78.70% were seen among all patients, AA women and Caucasian women, respectively. These probabilities increased to 87.62%, 87.15% and 89.99% in period B. Improved survival in AA women may be attributed to the use of adjuvant chemotherapy, radiation, and hormonal therapy. Improved survival in Caucasian patients was attributed to the use of radiation therapy, as well as earlier detection resulting in more favorable tumor grades and pathological stages.
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Nozoe T, Mori E, Iguchi T, Ezaki T. New criteria to predict tumor recurrence in invasive ductal carcinoma of the breast. Int Surg 2013; 98:283-8. [PMID: 24229009 PMCID: PMC3829049 DOI: 10.9738/intsurg-d-12-00029.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Incidence of triple-negative breast cancer (TNBC), which is cancer without expression of ER, PgR, and HER2, and nuclear grade (NG) are closely correlated with malignant potential of breast cancer. However, criteria to determine aggressiveness of breast cancer based on these factors have not been elucidated. The aim of this study was to create criteria using these factors to predict tumor recurrence in invasive ductal carcinoma (IDC) of the breast. One hundred and seventy-nine patients with IDC of the breast, which had been treated by surgical resection, were included. One point was added for each factor of the two categories of TNBC and NG 3. The sum of the scores (TGS 0, 1, or 2) was calculated. Significant difference was observed between TGS and the incidence of tumor recurrence (P < 0.0001). Moreover, significant differences were observed regarding relapse-free survival (RFS) between patients with TGS 0 and TGS 1 (P < 0.0001) and patients with TGS 1 and TGS 2 (P = 0.024). TGS might contain a clinical advantage as a useful predictor for tumor recurrence of IDC of the breast and could classify prognosis of the patients with a preferable stratification.
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Affiliation(s)
- Tadahiro Nozoe
- Department of Surgery, Fukuoka Higashi Medical Center, Koga, Japan
| | - Emiko Mori
- Department of Surgery, Fukuoka Higashi Medical Center, Koga, Japan
| | - Tomohiro Iguchi
- Department of Surgery, Fukuoka Higashi Medical Center, Koga, Japan
| | - Takahiro Ezaki
- Department of Surgery, Fukuoka Higashi Medical Center, Koga, Japan
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Pogoda K, Niwińska A, Murawska M, Pieńkowski T. Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol 2013; 30:388. [PMID: 23292831 PMCID: PMC3586394 DOI: 10.1007/s12032-012-0388-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/20/2012] [Indexed: 12/31/2022]
Abstract
The aim of the study was to assess the rate, pattern, and time of recurrence in patients with triple-negative breast cancer (TNBC) and to evaluate factors influencing recurrence and overall survival in this group of patients. Out of 2,534 consecutive breast cancer patients diagnosed between January 2005 and December 2006, 228 (9 %) were TNBC (ER/PR/HER2-negative). The clinicopathological characteristics were determined using descriptive statistics. The overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. The univariate and multivariate analyses were developed to identify factors influencing recurrence and survival in TNBC patients. After 6 years of observation, metastatic disease occurred in 35 % of all TNBC patients: 15 % in the brain, 14 % in the lungs, 11 % in the bones, 8 % in the liver, and 14 % had locoregional relapse. The highest risk of recurrence was during the first 3 years after primary treatment, and then, during the next 2 years of observation, it did not change. 6-year DFS and OS were 68 and 62 %, respectively. Factors influencing recurrence were tumor size and systemic adjuvant chemotherapy, while factors influencing overall survival were tumor size, nodal status, adjuvant/neoadjuvant treatment, and metastases in the brain, liver, and bones. Characteristic pattern of recurrence in time was revealed. The tumor size was responsible for recurrence despite lack of involvement of lymph nodes. Aggressive adjuvant/neoadjuvant treatment ordered in all clinical stages of TNBC (including N0) was factor responsible for avoiding local and distant relapse and prolonging overall survival.
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Affiliation(s)
- Katarzyna Pogoda
- Department of Chemotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
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