Triple negative breast cancer in North of Morocco: clinicopathologic and prognostic features

Clinicopathological, Treatment and Event-Free Survival Characteristics in a Moroccan Population of Triple-Negative Breast Cancer

Introduction:

Triple-negative breast cancer (TNBC) is a group of breast carcinoma characterized by the lack of expression of estrogen and progesterone hormone receptors (ER, PgR) and HER2. This form is also characterized by its aggressiveness, a low survival rate, and the absence of targeted therapies. This study was planned to evaluate the clinical features, treatment, and prognosis characteristics of TNBC in a population of Moroccan patients.

Methods:

In this retrospective study, a total of 905 patients diagnosed with breast cancer at the National Institute of Oncology in Rabat, Morocco, have been included. Based on molecular subtype, patients were divided into 2 categories: TNBC and non-TNBC patients. Data were recorded from patients’ medical files and analyzed using SPSS 13.0 software (IBM).

Results:

Overall, 17% of the patients had TNBC. At diagnosis, the median age of TNBC cases was 47 years, with extreme ages of 40 and 55 years. The median follow-up time was 30 months (10-53 months) and the 3-year survival rate was 76%. No significant difference was observed among the patients in terms of age at diagnosis, age at menarche, age at the time of first birth, nulliparity, oral contraception, and family history of breast cancer. Menopausal status and the number of pregnancy were significantly higher in the non-TNBC group. The percentage of grade 3 (G3) tumors was higher in the TNBC group (P < .001). Using neoadjuvant, adjuvant chemotherapy and radiotherapy, a net benefit in the event-free survival was registered for the 2 groups.

Conclusions:

This retrospective study was very informative and showed that women with TNBC had a less favorable prognosis than non-TNBC cases. Clinical data demonstrated that risk factors including age, premenopausal status, parity, hormonal contraceptive use, advanced disease, and a high histologic grade were independently associated with TNBC. However, large tumors and high Scarff-Bloom and Richardson grade prevail in TNBC cases with a higher incidence of lymph node metastases.

Survival Rate of Breast Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis

Background:

Breast cancer (BC) is one of the main problems of public health around the world. As a consequence, survival rates are one of the most salient indicators for assessing the quality of cancer control and treatment programs.

Objectives:

The aim of this study is to evaluate the survival rate of breast cancer in the Eastern Mediterranean region at different periods of time.

Methods:

Medline/PubMed, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar databases until February 1, 2018. All observational studies (cross-sectional, case-control, and cohort) referring to the survival of breast cancer were included in the study. The heterogeneity and its value were examined by Cochran test and I² statistics, respectively. Analysis of subgroups performed was based on geographical area and Human Development Index (HDI), using Stata 12 software.

Findings:

A total of 58 papers were analyzed. Based on a random effect model, the survival rates of breast cancer in different periods—1, 2, 3, 4, 5 and 10 years—were estimated at 93.9, 85, 79.8, 72.6, 69.2, 62.1 and 55.5 percent, respectively. The highest 10-year survival rate was in Iran (59.2%), and the lowest was observed in Bahrain (45%).

Conclusions:

Evidence suggests that about half of the patients in this area would die before 10 years survival, which is different from more developed countries. Also, high survival rates are associated with high human development index, which can help health policy-makers to better predict the outcomes of patients.

Treatment response as predictor for brain metastasis in triple negative breast cancer: A score-based model

BACKGROUND

Triple negative breast cancer (TNBC) has worse prognosis than other subtypes of breast cancer, and many patients develop brain metastasis (BM). We developed a simple predictive model to stratify the risk of BM in TNBC patients receiving neo-adjuvant chemotherapy (NAC), surgery, and radiation therapy (RT).

METHODS

Patients with TNBC who received NAC, surgery, and RT were included. Cox proportional hazards method was used to evaluate factors associated with BM. Significant factors predictive for BM on multivariate analysis (MVA) were used to develop a risk score. Patients were divided into three risk groups: low, intermediate, and high. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of the risk group in predicting BM. This predictive model was externally validated.

RESULTS

A total of 160 patients were included. The median follow-up was 47.4 months. The median age at diagnosis was 49.9 years. The 2-year freedom from BM was 90.5%. Persistent lymph node positivity, HR 8.75 (1.76-43.52, P = 0.01), and lack of downstaging, HR 3.46 (1.03-11.62, P = 0.04), were significant predictors for BM. The 2-year rate of BM was 0%, 10.7%, and 30.3% (P < 0.001) in patients belonging to low-, intermediate-, and high-risk groups, respectively. Area under the ROC curve was 0.81 (P < 0.001). This model was externally validated (C-index = 0.79).

CONCLUSIONS

Lack of downstaging and persistent lymph node positivity after NAC are associated with development of BM in TNBC. This model can be used by the clinicians to stratify patients into the three risk groups to identify those at increased risk of developing BM and potentially impact surveillance strategies.

Nottingham Prognostic Index is an Applicable Prognostic Tool in Non-Metastatic Triple-Negative Breast Cancer

Introduction:

Triple-negative breast cancer (TNBC) is characterized by a poor prognosis due to high mortality and early relapse, requiring the study of its prognostic factors. Tumor size, histological grade and lymph node status represent important parameters that are widely studied in breast cancer, and are retained as prognostic factors by several international guidelines. The Nottingham team combined these parameters into a prognostic score called the Nottingham prognostic index (NPI). In this study, we investigated the influence of NPI on outcomes in non metastatic TNBC.

Methodology:

This retrospective cohort study included all female patients with non metastatic TNBC who received treatment at the Regional Oncology Center Hassan II Oujda - Morocco, between January 2009 and December 2011. The prognostic impact of the NPI on the survival curves at 5 years was studied using multivariate Cox proportional hazards models.

Results:

The analysis of the data involved 98 patients, 39 patients (39.8%) were classed in the poor prognosis group with a NPI > 5.4. The Overall survival (OS) and Disease free survival (DFS) rates at 5 years, in this group, were 70 and 55.6 % respectively. After adjusting for clinic-pathological variables, a NPI > 5.4 was associated with mortality (HR: 2.598, 95% CI: 1.423 – 4.744, p = 0.002) and disease progression (HR: 2.512, CI to 95%: 1.496 – 4.219, p <0.001) in patients with non-metastatic TNBC.

Conclusion:

This retrospective cohort analysis showed that NPI was an independent prognostic factor for OS and DFS at 5 years in women with non metastatic TNBC. Once validated, the impact of this score on survival outcomes could be considered in the clinical management of TNBC.

Descriptive study of triple negative breast cancer in Eastern Algeria

Introduction

Triple-negative breast cancer (TNBC) is characterized by the lack of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 (HER-2) expression. It is aggressive and most common in African women. In this study we identified the frequency, clinical an pathological characteristics of this type in a cohort of women in Eastern Algeria.

Methods

We conducted a retrospective study between January 2010 and December 2015 at the regional hospital of Constantine in eastern Algeria. Among 472 women with breast cancer, 102 women had a TNBC. Clinical and pathological features and overall survival were analyzed.

Results

21.61% of patients had TNBC with a median age of 52 years. 65.31% of the patients were menopausal. Only 6.82% of women had a family history of breast cancer. The majority of patients had infiltrating ductal carcinoma (96.08%), the proportion of grade III SBR was 53.92%. The average tumor size was 4.4cm and 70.1% of the tumors had a very large size (T2 and T3). 69.07% of patients had positive lymph nodes, vascular invasion was found in 48.57% of cases. Metastatic sites were bone in 16.13% of cases, hepatic in 3.26% and pulmonary in 0.98%. For treatment modalities, 95.24% underwent surgery and adjuvant chemotherapy. 33.33% of patients have received neoadjuvant chemotherapy with 29% of complete pathologic response (pCR) and 96.97% have received radiotherapy. Overall Survival (OS) for all patients at 5 years was 45.2%.

Conclusion

Most of our results are in accordance with literature data, however we noted some discrepancies. In this study, TNBC is more common in menopausal women than non menopausal women and characterized by a low rate of visceral metastases and a lower overall survival at 5 years.

Clinicopathologic and prognostic features of breast cancer in young women: a series from North of Morocco

BACKGROUND

Literature data reported a higher frequency of breast cancer in young women (BCYW) in developing countries. BCYW is associated with delayed diagnosis, aggressive biology and poor prognosis. However, our knowledge of biological profile, treatment received and outcome of young patients is still limited in Morocco. We propose to analyze clinicopathologic, therapeutic and prognostic features of BCYW among a series of patients native and/or inhabitant of North of Morocco.

METHODS

We carried out a retro-prospective study of 331 infiltrating breast cancer cases registered between January 2010 and December 2015. Details of tumor pathology, treatment and outcome were collected. Disease-Free Survival (DFS) and Overall Survival (OS) were assessed by Kaplan-Meier analysis.

RESULTS

A total of 82 patients were diagnosed with breast cancer at the age of 40 or younger (24.8%). Median age was 36 years. More than one quarter (26%) of patients had family history of breast or ovarian cancer. Advanced stages accounted for 34.2% of cases. Median tumor diameter was 2.8 cm. Intermediate and high-grade tumors represented 47.6% and 40.2%, respectively. Nodal involvement was present in 58.5% and lymphovascular invasion was found in 47.7% of the patients. About two thirds (66.2%) of tumors were hormone receptor positive, 29.2% over-expressed HER2 receptor and 23% were triple negative. Patients underwent breast conserving surgery in 38.2% of cases, 61.7% were offered adjuvant chemotherapy and 84.6% received hormone therapy. Five-year DFS and OS were respectively 88.9% and 75.6%. Locoregional recurrence occurred in 2.8% of cases and 8.3% of patients developed distant metastases.

CONCLUSION

Our findings are in accordance with previous studies that have shown a higher frequency of breast cancer among Moroccan young women. In line with literature data, clinicopathologic profile seems to be aggressive and prognosis is pejorative in our series.

Triple Negative Breast Cancer at the University Hospital Mohammed VI – Oujda

Introduction: The triple-negative breast cancer (TNBC), defined by the absence of receptors to oestrogen and progesterone and no histochemical expression of human epidermal receptor -2, is associated with a particularly aggressive behavior. The aim of our study was to determine the clinico-pathological, therapeutic and prognostic features associated with this type of breast cancer in Morocco. Methods: A cohort retrospective study, spread over 3 years, was conducted of 116 breast cancer patients, diagnosed between January 2009 and December 2011 at the Regional Center of Oncology. Epidemiological, clinical, histological and therapeutic data were analyzed. Survival curves at 3 years were estimated by Kaplan-Meier analysis with use of the log-rank test. Results: The proportion of triple-negative breast cancer in our series was 13.2%. The average age was 46.5 years and 20,7% had a previous history of familial breast cancer. Some 56,9% of tumors were greater than 3 cm in diameter. infiltrating ductal carcinoma being the histological type in the majority of cases (75.9%). TNBC was most often associated with a high grade, grade III accounting for 50.9%. Vascular invasion was found in 58.6% of cases. Regarding lymph node involvement, 42.2% had positive lymph nodes and 15.5% featured distant metastases. Neoadjuvant chemotherapy was administrated to 20% of patients with a 23.5% complete pathologic response. The rates for overall survival and disease-free-survival at 3 years for localized stages were 70 and 55.6%, respectively. With metastatic lesions, the figures were 27.5% and 10.3% respectively. Conclusion: The TNBC is correlated with a poor prognosis with a high mortality and early relapse requiring identification of new target therapies and markers for prediction of tumoral response to various treatments.