Abdul Aziz Ahmad Aizat, Md Salleh Md Salzihan, Ankathil Ravindran
Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
Int J Breast Cancer. 2020 Apr 1;2020:8424365. doi: 10.1155/2020/8424365. eCollection 2020.
Triple negative breast cancer (TNBC) is associated with aggressive tumour phenotype and early tumour relapse following diagnosis. Generally, clinicopathological features such as tumour size, patient's age at diagnosis, tumour histology subtypes, grade and stage, involvement of lymph nodes, and menopausal status are commonly used for predicting disease progression, prospects of recurrence, and treatment response. Prognostic value of clinicopathological features on Malaysian TNBC patients is limited. Thus, this study is aimed at investigating the association of clinicopathological features on disease-free survival (DFS) and overall survival (OS) of Malaysian TNBC patients undergoing TAC chemotherapy. Seventy-six (76) immunohistochemistry-confirmed TNBC patients were recruited. The clinicopathological features of TNBC patients were collected and recorded. Kaplan-Meier and log-rank followed by a Cox proportional hazard regression model were performed to evaluate the TNBC patients' survival. Out of 76 TNBC patients, 25 were chemoresistant and 51 were chemoresponders to the TAC chemotherapy regimen. The overall 5-year cumulative DFS and OS of TNBC patients were 63.5% and 76.3%, respectively. Multivariate Cox analysis demonstrated that medullary and metaplastic histology subtypes and positive axillary lymph node metastasis were significant prognostic factors associated with relapse with adjusted HR: 5.76, 95% CI: 2.35, 14.08 and adjusted HR: 3.55, 95% CI: 1.44, 8.74, respectively. Moreover, TNBC patients with medullary and metaplastic histology subtypes and positive axillary lymph node metastases had a higher risk to death than patients who had infiltrating ductal carcinoma and negative axillary lymph node metastasis (adjusted HR: 8.30, 95% CI: 2.38, 28.96 and adjusted HR: 6.12, 95% CI: 1.32, 28.42, respectively). Our results demonstrate the potential use of medullary and metaplastic histology subtype and positive axillary lymph node metastasis as a potential biomarker in predicting relapse and survival of the TNBC patients. This warrants further studies on intensification of chemotherapy and also identification and development of targeted therapy to reduce relapses and improve survival of TNBC patients.
三阴性乳腺癌（TNBC）与侵袭性肿瘤表型及诊断后早期肿瘤复发相关。一般而言，肿瘤大小、患者诊断时年龄、肿瘤组织学亚型、分级和分期、淋巴结受累情况以及绝经状态等临床病理特征通常用于预测疾病进展、复发前景及治疗反应。临床病理特征对马来西亚TNBC患者的预后价值有限。因此，本研究旨在调查临床病理特征与接受TAC化疗的马来西亚TNBC患者无病生存期（DFS）和总生存期（OS）之间的关联。招募了76例经免疫组织化学确诊的TNBC患者。收集并记录TNBC患者的临床病理特征。采用Kaplan-Meier法和对数秩检验，随后进行Cox比例风险回归模型分析，以评估TNBC患者的生存情况。在76例TNBC患者中，25例对化疗耐药，51例对TAC化疗方案有化疗反应。TNBC患者的5年累计DFS和OS分别为63.5%和76.3%。多变量Cox分析表明，髓样和化生组织学亚型以及腋窝淋巴结转移阳性是与复发相关的显著预后因素，调整后HR分别为：5.76，95%CI：2.35，14.08和调整后HR：3.55，95%CI：1.44，8.74。此外，具有髓样和化生组织学亚型以及腋窝淋巴结转移阳性的TNBC患者比浸润性导管癌和腋窝淋巴结转移阴性的患者死亡风险更高（调整后HR分别为：8.30，95%CI：2.38，28.96和调整后HR：6.12，95%CI：1.32，28.42）。我们的结果表明，髓样和化生组织学亚型以及腋窝淋巴结转移阳性有可能作为预测TNBC患者复发和生存的生物标志物。这值得进一步研究强化化疗，以及识别和开发靶向治疗，以减少TNBC患者的复发并提高其生存率。
