Eralp Yeşim, Kılıç Leyla, Alço Gül, Başaran Gül, Doğan Mutlu, Dinçol Dilek, Demirci Senem, İçli Fikri, Onur Handan, Saip Pınar, Haydaroğlu Ayfer
Department of Medical Oncology, İstanbul University Faculty of Medicine, İstanbul, Turkey.
Department of Medical Oncology, Fırat University Hospital, Elazığ, Turkey.
J Breast Health. 2014 Oct 1;10(4):209-215. doi: 10.5152/tjbh.2014.1904. eCollection 2014 Oct.
Triple negative breast cancer (TNBC) is generally considered as a poorer prognostic subgroup, with propensity for earlier relapse and visceral involvement. The aim of this study is to evaluate the outcome of non-metastatic TNBC patients from different centers in Turkey and identify clinical and pathologic variables that may effect survival.
Between 1993-2007, from five different centers in Turkey, 316 nonmetastatic triple negative breast cancer patients were identified with follow-up of at least 12 months. The data was collected retrospectively from patient charts. The prognostic impact of several clinical variables were evaluated by the Kaplan-Meier and Cox multivariate anayses.
Mean age at diagnosis was 49 years (range: 24-82). The majority of the patient group had invasive ductal carcinoma (n: 260, 82.3%) and stage II disease (n: 164; 51.9%). Majority of the patients (87.7%) received adjuvant chemotherapy. 5 year overall survival (OS) and disease-free survival (DFS) rates were 84.6% and 71.6%, respectively. Univariate analysis revealed locally advanced disease (p: 0.001), advanced pathological stage (p: 0.021), larger tumor size (T1&T2 vs T3&T4) (p<0.001), nodal positivity (p: 0.006), and extensive nodal involvement (p<0.001) as significant factors for DFS; whereas, advanced pathological stage (p: 0.017), extensive nodal involvement (p<0.001) and larger tumor size (p: 0,001) and presence of breast cancer-affected member in the family (p=0.05) were identified as prognostic factors with an impact on OS. Multivariate analysis revealed larger tumor size (T3&T4 vs T1&T2) and presence of lymph node metastases (node-positive vs node-negative) as significant independent prognostic factors for DFS (Hazard ratio (HR): 3.03, 95% CI: 1.71-5.35, p<0.001 and HR: 1.77, 95% CI: 1.05-3.0, p=0.03, respectively). Higher tumor stage was the only independent factor affecting overall survival (HR: 2.81; 95% CI, 1.27-6.22, p=0.01).
The outcome of patients with TNBC in this cohort is comparable to other studies including TNBC patients. Tumor size and presence of lymph node metastasis are the major independent factors that have effect on DFS, however higher tumor stage was the only negative prognostic factor for OS.
三阴性乳腺癌（TNBC）通常被认为是预后较差的亚组，具有早期复发和内脏受累的倾向。本研究的目的是评估土耳其不同中心的非转移性TNBC患者的预后，并确定可能影响生存的临床和病理变量。
1993年至2007年间，从土耳其五个不同中心确定了316例非转移性三阴性乳腺癌患者，随访至少12个月。数据从患者病历中回顾性收集。通过Kaplan-Meier和Cox多变量分析评估了几个临床变量的预后影响。
诊断时的平均年龄为49岁（范围：24 - 82岁）。患者组大多数患有浸润性导管癌（n = 260，82.3%）和II期疾病（n = 164；51.9%）。大多数患者（87.7%）接受了辅助化疗。5年总生存率（OS）和无病生存率（DFS）分别为84.6%和71.6%。单变量分析显示局部晚期疾病（p = 0.001）、晚期病理分期（p = 0.021）、较大肿瘤大小（T1&T2与T3&T4）（p < 0.001）、淋巴结阳性（p = 0.006）和广泛淋巴结受累（p < 0.001）是DFS的重要因素；而晚期病理分期（p = 0.017）、广泛淋巴结受累（p < 0.001）、较大肿瘤大小（p = 0.001）以及家族中有乳腺癌患者（p = 0.05）被确定为对OS有影响的预后因素。多变量分析显示较大肿瘤大小（T3&T4与T1&T2）和存在淋巴结转移（淋巴结阳性与淋巴结阴性）是DFS的重要独立预后因素（风险比（HR）：3.03，95%置信区间：1.71 - 5.35，p < 0.001和HR：1.77，95%置信区间：1.05 - 3.0, p = 0.03）。较高的肿瘤分期是影响总生存的唯一独立因素（HR：2.81；95%置信区间，（1.27 - 6.22），p = 0.01）。
该队列中TNBC患者的预后与其他纳入TNBC患者的研究相当。肿瘤大小和淋巴结转移的存在是影响DFS的主要独立因素，然而较高的肿瘤分期是OS的唯一不良预后因素。
