Favorable prognosis in patients with T1a/T1bN0 triple‐negative breast cancers treated with multimodality therapy

Abstract

BACKGROUND:The authors evaluated the clinical characteristics, natural history, and outcomes of patients who had 1 cm, lymph node-negative, triple-negative breast cancer (TNBC). METHODS: After excluding patients who had received neoadjuvant therapy, 1022 patients with TNBC who underwent definitive breast surgery during 1999 to 2006 were identified from an institutional database. In total, 194 who had lymph node-negative tumors that measured 1 cm comprised the study population. Clinical data were abstracted, and survival outcomes were analyzed. RESULTS: The median follow-up was 73 months (range, 5-143 months). The median age at diagnosis was 55.5 years (range, 27-84 years). Tumor (T) classification was microscopic (T1mic) in 16 patients (8.2%), T1a in 49 patients (25.3%), and T1b in 129 patients (66.5%). Most tumors were poorly differentiated (n ¼ 142; 73%), lacked lymphovascular invasion (n ¼ 170; 87.6%), and were detected by screening (n ¼ 134; 69%). In total, 129 patients (66.5%) underwent breast-conserving surgery, and 65 patients (33.5%) underwent mastectomy. One hundred thirteen patients (58%) received adjuvant chemotherapy, and 123 patients (63%) received whole-breast radiation. The patients who received chemotherapy had more adverse clinical and disease features (younger age, T1b tumor, poor tumor grade; all P < .05). Results from testing for the breast cancer (BRCA) susceptibility gene were available for 49 women: 19 women had BRCA1 mutations, 7 women had BRCA2 mutations, and 23 women had no mutations. For the entire group, the 5-year local recurrence-free survival rate was 95%, and the 5-year distant metastasis-free survival rate was 95%. There was no difference between patients with T1mic/T1a tumors and patients with T1b tumors in the distant recurrence rate (94.5% vs 95.5%, respectively; P ¼ .81) or in the receipt of chemotherapy (95.9% vs 94.5%, respectively; P ¼ .63). CONCLUSIONS: Excellent 5-year locoregional and distant control rates were achievable in patients with TNBC who had tumors 1.0 cm, 58% of whom received chemotherapy. These results identified a group of patients with TNBC who had favorable outcomes after early detection and multimodality treatment. Cancer 2012;118:4944-52.

Clinical Activity of Adjuvant Cytokine-Induced Killer Cell Immunotherapy in Patients with Post-Mastectomy Triple-Negative Breast Cancer

“…Although TNBC is characterized by an especially poor prognosis, an excellent survival rate has been reported following chemotherapy in a subset of patients with TNBC with early-stage disease (50). Consistent with previous observations, our study also found that patients with TNBC who were lymph node negative, early TNM stage, and low pathologic grade had better DFS and OS rates.…”

Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

“…Three retrospective studies have examined the incidence of local failure in TNBC after BCT or mastectomy and found no difference based on surgical procedure, suggesting that these local recurrences are more likely a result of aggressive biology, not residual tumor at the surgical site, which could be improved with wider lumpectomy margins. 29,[37][38][39] This theory is supported by the approximately 40 % decline in IBTR seen in patients with HER2-positive tumors receiving adjuvant systemic trastuzumab and other HER2-targeted agents. 29 In summary, the MP concluded that although there is evidence that the risk of IBTR varies by subtype based on the results of many studies, patients with aggressive tumors remain at equally increased risk for local failure irrespective of treatment with mastectomy or BCT, indicating there is no justification for more widely clear margins over no ink on tumor for any BC subtype.…”

The importance of BRCA1 gene 5382insC mutation detection in an asymptomatic patient: a case report

“…• Also there is chemotherapy treatment which is effective because research shows that the 5-year local recurrence-free survival rate with multimodality therapy was 95% (Ho, 2012).…”