Clinical and pathological factors influencing survival in a large cohort of triple-negative breast cancer patients

Abstract

BackgroundTo provide further information on the clinical and pathological prognostic factors in triple-negative breast cancer (TNBC), for which limited and inconsistent data are available.MethodsPathological characteristics and clinical records of 841 TNBCs diagnosed between 1994 and 2015 in four major oncologic centers from Sardinia, Italy, were reviewed. Multivariate hazard ratios (HRs) for mortality and recurrence according to various clinicopathological factors were estimated using Cox proportional hazards models.ResultsAfter a mean follow-up of 4.3 years, 275 (33.3%) TNBC patients had a progression of the disease and 170 (20.2%) died. After allowance for study center, age at diagnosis, and various clinicopathological factors, all components of the TNM staging system were identified as significant independent prognostic factors for TNBC mortality. The HRs were 3.13, 9.65, and 29.0, for stage II, III and IV, respectively, vs stage I. Necrosis and Ki-67 > 16% were also associated with increased mortality (HR: 1.61 and 1.99, respectively). Patients with tumor histotypes other than ductal invasive/lobular carcinomas had a more favorable prognosis (HR: 0.40 vs ductal invasive carcinoma). No significant associations with mortality were found for histologic grade, tumor infiltrating lymphocytes, and lymphovascular invasion. Among lymph node positive TNBCs, lymph node ratio appeared to be a stronger predictor of mortality than pathological lymph nodes stage (HR: 0.80 for pN3 vs pN1, and 3.05 for >0.65 vs <0.21 lymph node ratio), respectively. Consistent results were observed for cancer recurrence, except for Ki-67 and necrosis that were not found to be significant predictors for recurrence.ConclusionsThis uniquely large study of TNBC patients provides further evidence that, besides tumor stage at diagnosis, lymph node ratio among lymph node positive tumors is an additional relevant predictor of survival and tumor recurrence, while Ki-67 seems to be predictive of mortality, but not of recurrence.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3969-y) contains supplementary material, which is available to authorized users.

Predictors of Distant Metastases in Triple-Negative Breast Cancer Without Pathologic Complete Response After Neoadjuvant Chemotherapy

“…Regardless of the implications for survival, several groups have shown that the presence of LVSI predicts the development of distant metastatic disease. [21][22][23] Therefore, our results showing LVSI to be independently predictive of distant metastasis in patients without pCR are in accordance with the literature.…”

“…However, not all studies have shown LVSI to influence survival. Urru et al 21 found that LVSI was not significantly associated with survival in multivariate analysis. Regardless of the implications for survival, several groups have shown that the presence of LVSI predicts the development of distant metastatic disease.…”

Deep learning and manual assessment show that the absolute mitotic count does not contain prognostic information in triple negative breast cancer

“…However, so far no strong proliferation-based prognosticator specifically for this type of cancer has evolved. We previously found that histopathological subtype serves as an independent prognostic factor, potentially identifying a small subgroup (up to 30% [11][12][13]) of TNBC with a worse prognosis. The present study shows that mitotic counting does not yield any prognostic information for TNBC.…”

“…The vast majority of TNBCs is of histological grade 3, while grade 1 TNBCs are rare [11][12][13][14]. It has been suggested, however, that histological grade does not provide prognostic information for TNBC [11,15].…”

Comparison of Nottingham Prognostic Index, PREDICT and PrognosTILs in Triple Negative Breast Cancer –a Retrospective Cohort Study

“…Ovcaricek and coauthors described nodal status and age as independent prognostic factors for disease-free survival (DFS), whereas for overall survival (OS), only nodal status proved to be an independent factor [11]. Urru et al have demonstrated that tumor stage at diagnosis and positive lymph node ratio are relevant predictors of survival and tumor recurrence, with the addition of Ki-67 status for recurrence prediction [12]. Asaga and coworkers have used a different approach, and analyzed clinical response to preoperative systemic chemotherapy [13].…”