The prognostic impact of age in patients with triple-negative breast cancer

Liedtke, Cornelia; Hess, Kenneth R.; Karn, Thomas; Rody, Achim; Kiesel, L.; Hortobágyi, Gabriel N.; Pusztai, L.; González-Angulo, Ana M.

doi:10.1007/s10549-013-2461-x

Cited by 78 publications

(60 citation statements)

References 19 publications

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“…This was not unexpected and in line with several earlier reports [1-4, 11, 20]. This fact strongly urges us to perform any analyses separately by subtype as we and others have suggested previously, since the molecular subtype is one of the strongest prognostic factors [22,23,29,31,32]. It may also explain in part the differences in the survival rates in the overall cohort.…”

Section: Discussionsupporting

confidence: 89%

“…This has also been observed before, e.g., in both the microarray study of Azim and coleagues [4] and our previous study on triple negative breast cancers [23]. One potential reason could be that awareness of breast cancer may be greater around menopause than that in very young women both regarding patient and physician.…”

Section: Discussionsupporting

confidence: 82%

“…We had previously performed a study on age based on clinical and pathological data. In that study, we focused on a large cohort of a single breast cancer subtype (triple negative, n = 1732) and could show that patients with triple negative breast cancer aged \40 years suffer from a significantly adverse prognosis [23].…”

Section: Introductionmentioning

confidence: 99%

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The prognostic impact of age in different molecular subtypes of breast cancer

Liedtke

Rody

Gluz

et al. 2015

Breast Cancer Res Treat

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Breast cancer is a heterogeneous entity composed of distinct molecular subgroups with different molecular and clinical features. We analyzed the association between molecular breast cancer subgroups, age at diagnosis, and prognosis in a compilation of publicly available gene expression datasets. Affymetrix gene expression data (U133A or U133Plus2.0 arrays) of 4467 breast cancers from 40 datasets were compiled and homogenized. Breast cancer subgroups were defined based on expression of ESR1, PR, HER2, and Ki67. Event-free survival was calculated as recurrence-free survival or distant metastasis-free survival if recurrence-free survival was not available. Young age at diagnosis is associated with higher frequency of triple negative and HER2 subtypes and lower frequency of luminal A breast cancers. The 5-year event-free survival rates of patients aged less than 40, between 40 and 50, and >50 years were 54.3 ± 3.5, 68.5 ± 1.9, and 70.4 ± 1.3 %, respectively. When controlling for breast cancer subtype, we found that age <40 years remained significantly associated with poor prognosis in triple negative breast cancer. The effect was modest in luminal tumors and not found in HER2 subtype. Both subtypes and age retained their significances in multivariate analysis. Association of age at diagnosis with molecular breast cancer subtype contributes to its important role as prognostic factor among patients with breast cancer. Still, within the group of triple negative breast cancer, young age <40 years has a significant prognostic value which was retained in multivariate analysis.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 82%

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The prognostic impact of age in different molecular subtypes of breast cancer

Liedtke

Rody

Gluz

et al. 2015

Breast Cancer Res Treat

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“…We have no information on the germline BRCA (gBRCA) mutation status. Although a Danish group suggests that there might be a difference in younger women (B35 years) compared to women , the age cut-off of 40 years used here is supported by data by Anders and colleagues [4] and others [39,40] who could not demonstrate differences in DFS in women below 40 years in a small subset of patients. This analysis cannot identify a subgroup within the young women who will not need an anthracycline/taxane-based therapy, as all women received this type of neoadjuvant chemotherapy.…”

Section: Discussionsupporting

confidence: 59%

Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials

Loibl

Jackisch

Lederer

et al. 2015

Breast Cancer Res Treat

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Young women with breast cancer (BC) have a worse survival partly due to more aggressive tumor characteristics; however, their response to chemotherapy seems better. We investigated to what extent the prognostic factor pathological complete remission (pCR) after neoadjuvant chemotherapy is applicable to young women. 8949 patients with primary BC and follow-up from eight German neoadjuvant trials were included. A subgroup of 1453 patients <40 years was compared with women aged 40-49 and ≥50 years regarding pCR (ypT0 ypN0), as well as disease free survival (DFS), local recurrence free survival (LRFS), distant disease free survival (DDFS), and overall survival (OS) overall, according to pCR status and subtypes defined by hormone-receptor (HR) status and HER2. pCR was strongly associated with age without a clear age cut-off. The pCR rate was significantly higher in the young compared with other age groups (20.9 vs. 17.7 vs. 13.7 %; p < 0.001). This difference was confined to triple-negative breast cancer (TNBC) and HR +/HER2-. DFS, DDFS, LRFS, and OS were significantly worse for young women. Age was independently prognostic for survival in HR +/HER2-, with women <40 years without pCR having a worse DFS compared to their counterparts with pCR. Young women are more likely to achieve pCR after neoadjuvant chemotherapy, especially in HR +/HER2- and TNBC. Age is not an important prognostic factor in TNBC and HR-/HER2 + but is in HR +/HER2-. Young women with a luminal-like BC seem to benefit more from neoadjuvant chemotherapy than older women, which needs to be taken into account.

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“…Unfortunately, patients with TNBC carry a more unfavorable prognosis compared to patients with other subtypes of breast cancer, which seems to be due to: (i) a lack of systemic therapies, given that endocrine therapy and HER2-targeted agents are not an option; and (ii) a more aggressive biological behavior that is mirrored by a predominance of grade 3 tumors, high proliferation rate, and visceral and particularly cerebral metastases [3]. This unfavorable prognosis is even more pronounced among patients of young age at diagnosis [4]. …”

Section: Definition Of Triple-negative Breast Cancermentioning

confidence: 99%

Genomic Profiling in Triple-Negative Breast Cancer

Liedtke¹,

Bernemann²,

Kiesel³

et al. 2013

Breast Care

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Triple-negative breast cancer (TNBC) is defined by a lack of hormone receptor expression as well as lack of over-expression/amplification of HER2/neu. Patients with TNBC show a significantly worse prognosis compared to patients with other breast cancer subtypes. TNBC, however, is a heterogeneous entity both with regard to clinical/pathological characteristics and molecular biology. This review summarizes the current data on TNBC with a particular focus on mutational and gene expression profiling and the association between TNBC and breast cancer stem cells.

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The prognostic impact of age in patients with triple-negative breast cancer

Cited by 78 publications

References 19 publications

The prognostic impact of age in different molecular subtypes of breast cancer

The prognostic impact of age in different molecular subtypes of breast cancer

Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials

Genomic Profiling in Triple-Negative Breast Cancer

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