Triple-negative breast cancer associated with worse survival, similar local recurrence

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1. Among women who underwent breast-conserving therapy, triple-negative breast cancer was associated with worse overall survival compared with other phenotypes.

2. There was no increased risk of local recurrence in those with triple-negative breast cancer.

Evidence Rating Level: 2 (Good)        

Study Rundown: Among women undergoing breast-conserving therapy, triple-negative breast cancer was associated with worse overall survival but not increased risk of local recurrence when compared with other phenotypes. Large sample size and the participation of roughly 20 surgeons allow for results that may be generalized to a broader range of clinical settings. Results are limited by the study’s observational design such that the results highlight a clinically relevant association but do not inform optimal surgical management. Future studies might compare outcomes in women with triple negative breast cancer undergoing breast-conserving therapies versus total mastectomy.

Click to read the study in JAMA Surgery

Relevant Reading: The Negative Effect of Triple-Negative Breast Cancer on Outcome after Breast-Conserving Therapy

In-Depth [prospective database study]: Researchers identified 1851 women who underwent breast-conserving therapy for newly diagnosed breast cancer with a median follow-up of 60 months. Participants were categorized based on tumor phenotype into luminal A (positive for Estrogen or Progesterone Receptor, negative for ERBB2, n=1341), luminal B (positive for ER or PR and ERBB2, n=212), ERBB2 (negative for ER and PR, positive for ERBB2, n=64), or Triple Negative (negative for all 3 markers, n=234). The primary outcome was local recurrence. Regional recurrence, distant recurrence and overall survival were also assessed.

Triple-negative cancer was not associated with an increased risk of local recurrence compared with the luminal A (HR=1.4, p=.43), luminal B (HR=1.6, p=.43), or ERBB2 (HR=1.1, p=.87) subtypes, but was associated with worse overall 5-year survival compared with luminal A (HR=3.5, p<.001) and luminal B (HR=3.7, p=.001) subtypes. Triple-negative breast cancer was associated with younger age at diagnosis, as well as larger, higher grade, and more advanced stage tumors compared with other subtypes.

By Maren Shapiro and Leah Hawkins, MD, MPH

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