Prognostic factors in triple-negative breast cancer: a retrospective cohort

Costa, Rafael Everton Assunção Ribeiro da; Oliveira, Fergus Tomás Rocha de; Araújo, Ana Lúcia Nascimento; Vieira, Sabas Carlos

doi:10.1590/1806-9282.20210249

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Revista da Associação Médica Brasileira

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Sumário

Original Article • Rev. Assoc. Med. Bras. 67 (7) • July 2021 • https://doi.org/10.1590/1806-9282.20210249 copy

Prognostic factors in triple-negative breast cancer: a retrospective cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Triple-negative breast cancer (TNBC) is characterized by lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expression and accounts for 15–20% of all breast cancers. This study aims to analyze prognostic factors related to a reduction in overall survival (OS), disease-free survival (DFS), and risk of mortality and recurrence in TNBC.

METHODS:

This is a retrospective observational cohort study. Medical records of 532 patients with breast cancer diagnosed from 2007 to 2020 were analyzed. Of these patients, 93 (17%) were women with TNBC. Ten medical records were excluded, and the final sample was composed of 83 women with TNBC. OS and DFS were estimated by the Kaplan-Meier model. Univariate analysis (log-rank test) and multivariate analysis (Cox regression) were used to examine prognostic factors related to a statistically significant reduction (p<0.05) in OS and DFS and increased risk of mortality and tumor recurrence.

RESULTS:

Smoking, advanced clinical stage, larger tumor size, angiolymphatic invasion, positive sentinel lymph node, axillary node involvement, higher cancer burden, surgical treatment with mastectomy, and recurrence were related to a significant decrease in OS and/or DFS and increased risk of mortality and/or recurrence in TNBC. The 10-year OS and DFS was around 61 and 65%, respectively.

CONCLUSIONS:

Advanced clinical stage, positive sentinel lymph node, axillary node involvement, surgical treatment with mastectomy, and higher residual cancer burden were related to a significant reduction in OS and DFS and increased risk of mortality and recurrence in TNBC.

KEYWORDS:
Survival analysis; Prognosis; Medical records; Pathological conditions; Anatomical; Triple-negative breast neoplasms

Variables		n (%)	Death(s) n (%)	Univariate analysis		Multivariate analysis
Variables		n (%)	Death(s) n (%)	Overall survival n (95%CI)	Log-rank test p-value	RR (95%CI)	Wald's test p-value
Age at diagnosis
	≤59 years	50 (60.2)	7 (14.0)	86.0 (73.2–94.2)	0.930	1.0	0.931
	≤60 years	33 (39.8)	5 (15.2)	84.8 (68.1–94.9)	0.930	1.05 (0.33–3.33)	0.931
Number of pregnancies
	None	17 (20.5)	2 (11.8)	88.2 (63.6–98.5)	0.358	1.0
	1	13 (15.7)	2 (15.4)	84.6 (54.6–98.1)		1.02 (0.14–7.28)	0.987
	2	22 (26.5)	5 (22.7)	77.3 (54.6–92.2)		2.19 (0.42–11.41)	0.352
	3	19 (22.9)	1 (5.3)	94.7 (74.0–99.9)		0.32 (0.03–3.53)	0.349
	4 and more	12 (14.5)	2 (16.7)	83.3 (51.6–97.9)		1.05 (0.14–7.71)	0.964
Smoking
	No	79 (95.2)	10 (12.7)	87.3 (78.0–93.8)	0.004	1.0	0.015
	Yes	4 (4.8)	2 (50.0)	50.0 (6.8–93.2)	0.004	7.28 (1.48–35.80)	0.015
Alcohol dependence
	No	78 (94.0)	10 (12.8)	87.2 (77.7–93.7)	0.094	1.0	0.118
	Yes	5 (6.0)	2 (40.0)	60.0 (14.7–94.7)	0.094	3.47 (0.73–16.46)	0.118
Hypertension
	No	60 (72.3)	7 (11.7)	88.3 (77.4–95.2)	0.517	1.0	0.520
	Yes	23 (27.7)	5 (21.7)	78.3 (56.3–92.5)	0.517	1.46 (0.46–4.70)	0.520
Diabetes
	No	73 (88.0)	10 (13.7)	86.3 (76.2–93.2)	0.328	1.0	0.341
	Yes	10 (12.0)	2 (20.0)	80.0 (44.4–97.5)	0.328	2.11 (0.45–9.81)	0.341
Family history (breast cancer)
	No	57 (68.7)	10 (17.5)	82.5 (70.0–91.2)	0.459	1.0	0.467
	Yes	26 (31.3)	2 (7.7)	92.3 (74.9–99.0)	0.459	0.56 (0.12–2.62)	0.467
Family history (cancers)
	No	42 (50.6)	6 (14.3)	85.7 (71.5–94.6)	0.824	1.0	0.825
	Yes	41 (49.4)	6 (14.6)	85.4 (70.8–94.4)	0.824	1.14 (0.36–3.54)	0.825
Clinical stage
	IB	25 (30.1)	1 (4.0)	96.0 (79.6–99.9)	0.019	1.0
	IIB	24 (28.9)	2 (8.3)	91.7 (73.0–99.0)		1.74 (0.16–19.49)	0.651
	IIIB	23 (27.7)	5 (21.7)	78.3 (56.3–92.5)		6.63 (0.77–57.31)	0.085
	IIIC and IV	11 (13.3)	4 (36.4)	63.6 (30.8–89.1)		10.67 (1.19–95.66)	0.034
Grade
	G2	45 (54.2)	6 (13.3)	86.7 (73.2–94.9)	0.932	1.0	0.933
	G3	38 (45.8)	6 (15.8)	84.2 (68.7–94.0)	0.932	0.95 (0.30–2.98)	0.933
Tumor size (cm)
	0–2.5	48 (57.8)	4 (8.3)	91.7 (68.7–94.0)	0.025	1.0	0.036
	>2.5	35 (42.2)	8 (22.9)	77.1 (59.9–89.6)	0.025	3.73 (1.09–12.74)	0.036
Lymphatic invasion
	No	63 (75.9)	3 (4.8)	95.2 (86.7–99.0)	<0.001	1.0	<0.001
	Yes	20 (24.1)	9 (45.0)	55.0 (31.5–76.9)	<0.001	17.48 (3.72–82.17)	<0.001
Vascular invasion
	No	67 (80.7)	5 (7.5)	92.5 (83.4–97.5)	<0.001	1.0	0.001
	Yes	16 (19.3)	7 (47.8)	56.2 (29.9–80.2)	<0.001	7.59 (2.20–26.18)	0.001
Sentinel lymph node
	Negative	63 (75.9)	6 (9.5)	90.5 (80.4–96.4)	0.009	1.0	0.017
	Positive	20 (24.1)	6 (30.0)	70.0 (45.7–88.1)	0.009	4.23 (1.29–13.88)	0.017
Axillary involvement
	No	45 (54.2)	3 (6.7)	93.3 (81.7–98.6)	0.025	1.0	0.039
	Yes	38 (45.8)	9 (23.7)	76.3 (59.8–88.6)	0.025	3.98 (1.07–14.76)	0.039
Ki-67 (%)
	≤60	34 (47.0)	4 (10.3)	89.7 (75.8–97.1)	0.232	1.0	0.243
	>60	44 (53.0)	8 (18.2)	81.8 (67.3–91.8)	0.232	2.05 (0.61–6.87)	0.243
Residual cancer burden
	pCR	42 (50.6)	2 (4.8)	95.2 (83.8–99.4)	<0.001	1.0
	RCB-I and RCB-II	29 (34.9)	2 (6.9)	93.1 (77.2–99.1)		1.99 (0.26–15.08)	0.505
	RCB-III	12 (14.5)	8 (66.7)	33.3 (9.9–65.1)		27.80 (4.74–162.9)	<0.001
Surgical treatment
	Conservative	61 (73.5)	6 (9.8)	90.2 (79.8–96.3)	0.012	1.0	0.020
	Mastectomy	22 (26.5)	6 (27.3)	72.7 (49.8–89.3)	0.012	3.93 (1.24–12.4)	0.020
Recurrence
	No	65 (78.3)	3 (4.6)	95.4 (87.1–99.0)	<0.001	1.0	0.001
	Yes	18 (21.7)	9 (50.0)	50.0 (26.0–74.0)	<0.001	15.38 (3.26–72.53)	0.001

Variables		n (%)	Recurrence(s) n (%)	Univariate analysis		Multivariate analysis
Variables		n (%)	Recurrence(s) n (%)	Disease-free survival n (95%CI)	Log-rank test p-value	RR (95%CI)	Wald's test p-value
Age at diagnosis (year)
	Up to 59	50 (60.2)	12 (24.0)	76.0 (61.8–86.9)	0.529	1.0	0.533
	60 or above	33 (39.8)	6 (18.2)	81.8 (64.5–93.0)	0.529	0.73 (0.33–3.33)	0.533
Number of pregnancies
	None	17 (20.5)	2 (11.8)	88.2 (63.6–98.5)	0.001	1.0
	1	13 (15.7)	5 (38.5)	61.5 (31.6–86.1)		3.44 (0.66–17.77)	0.140
	2	22 (26.5)	9 (40.9)	59.1 (36.4–79.3)		4.88 (1.05–22.67)	0.043
	3 or more	31 (37.3)	2 (6.4)	93.6 (78.6–99.2)		0.47 (0.07–3.34)	0.451
Smoking
	No	79 (95.2)	12 (20.2)	79.8 (69.2–88.0)	0.041	1.0	0.062
	Yes	4 (4.8)	2 (50.0)	50.0 (6.8–93.2)	0.041	4.20 (0.93–18.91)	0.062
Alcohol dependence
	No	78 (94.0)	16 (20.5)	79.5 (68.8–87.8)	0.350	1.0	0.362
	Yes	5 (6.0)	2 (40.0)	60.0 (14.7–94.7)	0.350	1.99 (0.45–8.73)	0.362
Hypertension
	No	60 (72.3)	14 (23.3)	76.7 (64.0–86.6)	0.471	1.0	0.476
	Yes	23 (27.7)	4 (17.4)	82.6 (61.2–95.0)	0.471	0.67 (0.22–2.03)	0.476
Diabetes
	No	73 (88.0)	16 (21.9)	78.1 (66.9–86.9)	0.791	1.0	0.793
	Yes	10 (12.0)	2 (20.0)	80.0 (44.4–97.5)	0.791	1.22 (0.28–5.36)	0.793
Family history (breast cancer)
	No	57 (68.7)	13 (22.8)	77.2 (64.2–87.3)	0.897	1.0	0.898
	Yes	26 (31.3)	5 (19.2)	80.8 (60.6–93.4)	0.897	0.93 (0.33–2.63)	0.898
Family history (cancers)
	No	42 (50.6)	9 (21.4)	78.6 (63.2–89.7)	0.930	1.0	0.930
	Yes	41 (49.4)	9 (22.0)	78.0 (62.4–89.4)	0.930	1.04 (0.41–2.63)	0.930
Clinical stage
	IB	25 (30.1)	1 (4.0)	96.0 (79.6–99.9)	0.017	1.0
	IIB	24 (28.9)	6 (25.0)	75.0 (53.3–90.2)		5.04 (0.61–41.9)	0.134
	IIIB	23 (27.7)	6 (26.1)	73.9 (51.6–89.8)		7.33 (0.88–61.06)	0.065
	IIIC and IV	11 (13.3)	5 (45.4)	54.6 (23.4–83.2)		15.25 (1.78–130.70)	0.013
Grade
	G2	45 (54.2)	10 (22.2)	77.8 (62.9–88.8)	0.633	1.0	0.635
	G3	38 (45.8)	8 (21.0)	79.0 (62.7–90.4)	0.633	0.80 (0.31–2.03)	0.635
Tumor size (cm)
	0–2.5	48 (57.8)	8 (16.7)	83.3 (69.8–92.5)	0.144	1.0	0.154
	>2.5	35 (42.2)	10 (28.6)	71.4 (53.7–85.4)	0.144	1.97 (0.78–5.02)	0.154
Lymphatic invasion
	No	63 (75.9)	11 (17.5)	82.5 (70.9–90.9)	0.072	1.0	0.082
	Yes	20 (24.1)	7 (35.0)	65.0 (15.4–59.2)	0.072	2.34 (0.90–6.10)	0.082
Vascular invasion
	No	67 (80.7)	13 (19.4)	80.6 (69.1–89.2)	0.336	1.0	0.343
	Yes	16 (19.3)	5 (31.2)	68.8 (41.3–89.0)	0.336	1.65 (0.58–4.66)	0.343
Sentinel lymph node
	Negative	63 (75.9)	10 (15.9)	84.1 (72.7–92.1)	0.008	1.0	0.017
	Positive	20 (24.1)	8 (40.0)	60.0 (36.0–80.9)	0.008	3.23 (1.27–8.22)	0.017
Axillary involvement
	No	45 (54.2)	5 (11.1)	88.9 (75.9–96.3)	0.009	1.0	0.016
	Yes	38 (45.8)	13 (34.2)	65.8 (48.6–80.4)	0.009	3.57 (1.27–10.02)	0.016
Ki-67 (%)
	≤60	34 (47.0)	5 (12.8)	87.2 (72.6–95.7)	0.066	1.0	0.077
	>60	44 (53.0)	13 (29.6)	70.4 (54.8–83.2)	0.066	2.53 (0.90–7.11)	0.077
Residual cancer burden
	pCR	42 (50.6)	1 (2.4)	97.6 (87.4–99.9)	<0.001	1.0
	RCB-I	8 (9.6)	1 (12.5)	87.5 (47.3–99.7)		4.34 (0.27–69.60)	0.300
	RCB-II	21 (25.3)	5 (23.8)	76.2 (52.8–91.8)		15.22 (1.77–130.82)	0.013
	RCB-III	12 (14.5)	11 (91.7)	8.3 (0.2–38.5)		74.10 (9.39–584.45)	<0.001
Surgical treatment
	Conservative	61 (73.5)	11 (18.0)	82.0 (70.0–90.6)	0.025	1.0	0.033
	Mastectomy	22 (26.5)	7 (31.8)	68.2 (45.1–86.1)	0.025	2.83 (1.09–7.37)	0.033

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[1] *Corresponding author: rafaelearcosta@gmail.com