Triple-Negative Breast Cancer in Brazilian Women without Metastasis to Axillary Lymph Nodes: Ten-Year Survival and Prognostic Factors
Ana Lucia Amaral Eisenberg *
National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil. Address: Rua Cordeiro da Graça, 156, Santo Cristo, Rio de Janeiro, RJ, Brazil, CEP: 20220-400.
Isabella Vitral Pinto
Department of Pharmaceutical Care, Ministry of Health, Brasília, DF, Brazil.
Sergio Koifman
National School of Public Health, Oswaldo Cruz Foundation (FIOCRUZ), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil; CEP: 21041-210.
*Author to whom correspondence should be addressed.
Abstract
Aims: To determine the 10-year overall survival (OS) in triple-negative (TN) and non-TN breast cancer (BC) patients, and to identify associated independent prognostic factors.
Study Design: Descriptive and survival.
Place and Duration of Study: Pathology Division at National Cancer Institute, Rio de Janeiro, Brazil, between 1992-1996.
Methodology: Population: 348 women patients with invasive ductal carcinoma without lymph node metastasis. Analyzed variables: age, treatment, surgery type, tumor size, skin involvement, histological grade, vascular invasion, estrogen and progesterone receptors, HER-2, Ki-67 and p53. Statistical analysis performed: Kaplan-Meier survival curves, log rank test, and multivariate Cox models.
Results: 27% of the studied women were categorized as TNBC and 73%, as non-TNBC. The former showed higher frequency of age <50yr, preoperative chemotherapy, tumors >5cm, high grade, vascular invasion, and positive p53, (P=.05). Ten-year OS among TNBC patients was 61.6%, and 70.1% for non-TNBC patients (P=.058). Survival was higher in TNBC patients treated with partial surgeries, tumors ≤5cm, without skin involvement, low grade, and Ki-67 negative (P=.05). Among non-TNBC patients, higher survival was observed in patients without skin involvement, low grade, no vascular invasion, and p53 negative, (P=.05). Cox modelization showed a 2-fold higher death risk for TNBC patients aged ≥50yr, about 2.5-fold higher risk related to preoperative chemotherapy, high grade tumor and skin involvement, and a 3.0-fold higher risk for Ki-67 positive patients (P=.05). For non-TNBC patients, a 2.0-fold increased death risk was verified in patients with skin involvement and vascular invasion (P=.05).
Conclusion: TNBC patients showed a worse prognosis and survival when compared to non-TNBC patients. A worse 10-yr survival among TNBC patients was associated with age ≥50yr, preoperative chemotherapy, skin involvement, high histological grade, and Ki-67 positive tumors. For non-TNBC patients, the worst prognosis was related to skin involvement and vascular invasion. These predictors need to be further validating by other studies.
Keywords: Breast cancer, triple-negative breast cancer, survival, prognostic factors.