Effects of Nodal Status and Extent of Surgery on Survival in Triple Negative Breast Cancer
Keywords:Triple negative breast cancer, nodal status, breast conservative therapy, modified radical mastectomy, survival.
Background: Triple Negative Breast Cancer (TNBC) is one of the most aggressive but least understood subtypes of breast cancer. The roles of nodal status and type of surgery while essential in determining the outcomes of patients with TNBC remain controversial and require more examination.
Materials and Methods: Clinical and pathological data were retrieved from 1990 until 2001 by retrospective chart review for patients with breast cancer at the American University of Beirut Medical Center. Out of 1455 patients, 524 had complete histological data, of which 138 (26.3%) were diagnosed with TNBC. Median follow up time of patients with TNBC was 3.34 years (Range 0.55 - 10 years). We used the Kaplan-Meier and Cox proportional hazard models to evaluate prognostic effects and estimate hazard ratios (HR).
Results: For the 138 patients with TNBC, median age at presentation was 50.91 years (Range 26 - 81). One-year, 5 and 10-year survivals for node-negative patients (N0) were respectively 98.3 %, 91.1% and 74.5 %, compared to 98.5%, 70.3 % and 42.2% for node-positive patients (N1-N3). Numerical nodal staging did not significantly correlate with survival. On multivariate analysis, higher stage (H.R 3.01) and Breast-Conserving Therapy (BCT) had a significant effect on the survival of TNBC patients (H.R 0.195)
Conclusion: Lymph node-positivity predicted poorer survival in patients with TNBC. However, within the group of patients with positive LN, the number of positive lymph nodes did not alter survival nor did the tumor size. BCT including radiation therapy had a better effect on survival when compared to mastectomy.
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