Steward Lauren, Conant Leah, Gao Feng, Margenthaler Julie A
Department of Surgery, Washington University School of Medicine, St. Louis, MI, USA.
Ann Surg Oncol. 2014 Jul;21(7):2165-71. doi: 10.1245/s10434-014-3546-4. Epub 2014 Feb 21.
We investigated the outcomes of patients with triple negative breast cancer ([TNBC] = estrogen receptor negative, progesterone receptor negative, and HER2 nonamplified).
We identified 414 patients with stage I-III TNBC treated between 1999 and 2008. Data included patient/tumor characteristics, surgical, systemic, and radiation treatment received, and breast cancer-specific survival. Data were compared using Chi square, Fisher exact test, and logistic regression. A p value <.05 was considered significant.
The cohort included 414 patients (mean age 53.8 ± 12.5 years) with a mean follow-up of 68.2 ± 36.4 months. Of 414 patients, 304 (73.4 %) had no evidence of recurrence, while 110 (26.6 %) had recurrent disease, including 19 (17.3 %) with isolated locoregional recurrence, 70 (63.6 %) with isolated distant recurrence, and 21 (19.1 %) with both. Of 91 patients with distant recurrences, lung was most common (n = 38), followed by brain (n = 32), bone (n = 31), and liver (n = 29). Factors significantly associated with recurrence included increasing tumor size, positive nodal status, increasing stage, and type of chemotherapy (adjuvant vs neoadjuvant). After controlling for all potential confounders in multivariate stepwise regression, these same factors were also found to be independent predictors of recurrence. In the survival analysis, these same factors, in addition to receipt of radiation were found to be predictive of survival.
Approximately 25 % of patients with TNBC experienced a locoregional and/or distant recurrence, resulting in greater than 75 % breast cancer-specific mortality for those who experienced a distant recurrence. The lack of targeted therapy for this aggressive breast cancer subtype likely contributed to this finding.
我们研究了三阴性乳腺癌（TNBC = 雌激素受体阴性、孕激素受体阴性且HER2未扩增）患者的预后情况。
我们确定了1999年至2008年间接受治疗的414例I - III期TNBC患者。数据包括患者/肿瘤特征、接受的手术、全身和放射治疗以及乳腺癌特异性生存率。使用卡方检验、Fisher精确检验和逻辑回归对数据进行比较。p值<.05被认为具有统计学意义。
该队列包括414例患者（平均年龄53.8±12.5岁），平均随访时间为68.2±36.4个月。在414例患者中，304例（73.4%）无复发证据，而110例（26.6%）有复发性疾病，包括19例（17.3%）孤立性局部区域复发、70例（63.6%）孤立性远处复发和21例（19.1%）两者皆有。在91例远处复发患者中，肺部最常见（n = 38），其次是脑（n = 32）、骨（n = 31）和肝（n = 29）。与复发显著相关的因素包括肿瘤大小增加、淋巴结阳性状态、分期增加以及化疗类型（辅助化疗与新辅助化疗）。在多变量逐步回归中控制所有潜在混杂因素后，这些相同因素也被发现是复发的独立预测因素。在生存分析中，这些相同因素以及接受放射治疗被发现可预测生存率。
大约25%的TNBC患者经历了局部区域和/或远处复发，对于那些经历远处复发的患者，导致超过75%的乳腺癌特异性死亡率。这种侵袭性乳腺癌亚型缺乏靶向治疗可能导致了这一结果。
