Effects of different treatments on prognosis of triple-negative breast cancer

doi:10.3760/cma.j.cn371439-20210409-00004

Abstract

Abstract:

Objective To analyze the clinical features and the effects of different treatments on 5-year overall survival (OS) rate and 5-year disease free survival (DFS) rate of stage 0-Ⅲ triple-negative breast cancer (TNBC). Methods The data of 209 patients diagnosed as stage 0-Ⅲ TNBC in Ward 2 of Department of General Surgery of the Fifth Medical Center of PLA General Hospital from January 2004 to December 2013 were selected. The relationships between the clinical features, treatments and 5-year OS rate, 5-year DFS rate were retrospectively analyzed. Kaplan-Meier method was used to draw survival curves, and Cox proportional risk model was used for multivariate analysis. Results Univariate analysis found that clinical stage and methods of surgery were associated with 5-year OS rate (χ²=52.615, P<0.001; χ²=17.329, P=0.001) and 5-year DFS rate (χ²=55.112, P<0.001; χ²=18.816, P<0.001). Multivariate analysis showed that clinical stage was an independent prognostic factor of DFS (HR=3.637, 95%CI: 2.146-6.164, P<0.001) and OS (HR=3.545, 95%CI: 2.091-6.009, P<0.001). For the TNBC patients without axillary lymph node metastasis (n=118), the 5-year OS rates of patients with breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection were 97.6%, 97.7%, 91.4%, 100% respectively, the 5-year DFS rates were 97.3%, 94.3%, 85.8%, 100% respectively, and there were no significant differences among the four groups (χ²=3.369, P=0.338; χ²=3.868, P=0.276). The 5-year OS rate (74.5% vs. 91.1%) and 5-year DFS rate (73.6% vs. 86.8%) were significantly different in patients receiving neoadjuvant chemotherapy (n=106) compared with those receiving adjuvant chemotherapy (n=80) (χ²=4.504, P=0.034; χ²=4.683, P=0.030). The patients receiving neoadjuvant chemotherapy had later clinical stages than those receiving adjuvant chemotherapy (χ²=35.314, P<0.001). There were no significant differences in 5-year OS rate and 5-year DFS rate between the patients receiving neoadjuvant chemotherapy and adjuvant chemotherapy with the same clinical stage (all P>0.05). The 5-year OS rates of patients with pathologic complete response (pCR), partial response (PR) and stable disease (SD) obtained by neoadjuvant chemotherapy were 100%, 75.8% and 57.1% respectively, and the 5-year DFS rates were 100%, 74.5% and 55.7% respectively, with statistically significant differences (χ²=10.086, P=0.006; χ²=10.399, P=0.006). Between the pCR group and the PR group, the 5-year OS rate (χ²=4.238, P=0.040) and 5-year DFS rate (χ²=4.525, P=0.033) were significantly different. Between the pCR group and the SD group, the 5-year OS rate (χ²=8.163, P=0.004) and 5-year DFS rate (χ²=8.509, P=0.004) were significantly different. Between the PR group and the SD group, the 5-year OS rate (χ²=3.931, P=0.047) and 5-year DFS rate (χ²=3.896, P=0.048) were significantly different. Conclusion For the patients with stage 0-Ⅲ TNBC, clinical stage is an independent prognostic factor. For the TNBC patients without axillary lymph node metastasis, breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection have similar outcomes. There is no significant difference between neoadjuvant chemotherapy and adjuvant chemotherapy in the prognosis of patients with the same clinical stage, but patients with pCR or PR obtained by neoadjuvant chemotherapy can achieve better survival.

Key words: Breast neoplasms, Prognosis, Surgery, Neoadjuvant chemotherapy

Liu Xiaojing, Zhu Minghua, Zuo Si, Meng Di, Bi Yan, Wang Wei, Jin Shujuan. Effects of different treatments on prognosis of triple-negative breast cancer[J]. Journal of International Oncology, 2022, 49(1): 33-38.

Figures/Tables 6

References 16

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临床病理特征	例数	5年DFS率(%)	χ²值	P值	5年OS率(%)	χ²值	P值
年龄(岁)
≤40	41	72.9	1.498	0.221	75.6	1.986	0.159
>40	168	81.9			84.4
临床分期
0	6	100	55.112	<0.001	100	52.615	<0.001
Ⅰ	55	92.6			96.4
Ⅱ	105	88.1			89.5
Ⅲ	43	40.9			45.3
病理类型
原位癌	14	100			100
浸润性癌	183	79.0	3.667	0.160	82.0	3.531	0.171
分化良好的癌	12	72.7			72.7
组织学分级
12	103	79.7			82.5
3	44	83.3	0.114	0.944	83.7	0.196	0.906
不详	62	78.8			82.3
手术方式
乳房全切+前哨淋巴结活检术	37	94.3	18.816	<0.001	97.3	17.329	0.001
保乳+前哨淋巴结活检术	37	97.3			97.3
改良根治术	117	69.5			72.4
保乳+腋窝淋巴结清扫术	18	82.4			88.9
化疗方式
新辅助化疗	106	73.6	6.072	0.108	74.5	5.620	0.132
辅助化疗	80	86.8			91.1
无	12	90.9			100
不详	11	81.8			81.8

临床病理特征	DFS			OS
临床病理特征	HR值	95%CI	P值	HR值	95%CI	P值
年龄	0.996	0.9651.028	0.808	0.993	0.9621.025	0.659
临床分期	3.637	2.1466.164	<0.001	3.545	2.0916.009	<0.001
病理类型	1.445	0.5114.085	0.488	1.384	0.4913.904	0.539
组织学分级	1.019	0.7251.434	0.912	1.052	0.7491.479	0.770
手术方式	1.220	0.7382.017	0.437	1.237	0.7492.044	0.406
化疗方式	0.850	0.5681.273	0.431	0.862	0.5761.292	0.473

手术方式	例数	5年DFS率(%)	χ²值	P值	5年OS率(%)	χ²值	P值
腋窝淋巴结转移(n=91)
改良根治术	79	62.7	0.885	0.347	64.1	0.822	0.365
保乳+腋窝淋巴结清扫术	12	75.0			83.3
腋窝淋巴结未转移(n=118)
乳房全切+前哨淋巴结活检术	37	94.3	3.868	0.276	97.7	3.369	0.338
保乳+前哨淋巴结活检术	37	97.3			97.6
改良根治术	38	85.8			91.4
保乳+腋窝淋巴结清扫术	6	100			100

指标	新辅助化疗 (n=106)	辅助化疗 (n=80)	χ²值	P值
临床分期
0Ⅰ	11(10.38)	38(47.50)
Ⅱ	64(60.38)	34(42.50)	35.314	<0.001
Ⅲ	31(29.25)	8(10.00)
病理类型
原位癌	0(0)	6(7.5)
浸润性癌	104(98.11)	66(82.50)	0.030	0.860
其他类型	2(1.89)	8(10.00)

临床分期	5年OS率(%)					5年DFS率(%)
临床分期	新辅助化疗 (n=106)	辅助化疗 (n=80)	χ²值	P值		新辅助化疗 (n=106)		辅助化疗 (n=80)		χ²值		P值
0Ⅰ	100	94.7	1.241	0.265	100		91.9		1.272		0.259
Ⅱ	85.9	97.1	1.930	0.165	85.5		93.7		1.869		0.172
Ⅲ	41.9	21.4	1.313	0.717	39.3		28.6		0.249		0.618