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BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Clinical and pathological factors influencing survival in a large cohort of triple-negative breast cancer patients

Authors: Silvana Anna Maria Urru, Silvano Gallus, Cristina Bosetti, Tiziana Moi, Ricardo Medda, Elisabetta Sollai, Alma Murgia, Francesca Sanges, Giovanna Pira, Alessandra Manca, Dolores Palmas, Matteo Floris, Anna Maria Asunis, Francesco Atzori, Ciriaco Carru, Maurizio D’Incalci, Massimo Ghiani, Vincenzo Marras, Daniela Onnis, Maria Cristina Santona, Giuseppina Sarobba, Enrichetta Valle, Luisa Canu, Sergio Cossu, Alessandro Bulfone, Paolo Cossu Rocca, Maria Rosaria De Miglio, Sandra Orrù

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

To provide further information on the clinical and pathological prognostic factors in triple-negative breast cancer (TNBC), for which limited and inconsistent data are available.

Methods

Pathological characteristics and clinical records of 841 TNBCs diagnosed between 1994 and 2015 in four major oncologic centers from Sardinia, Italy, were reviewed. Multivariate hazard ratios (HRs) for mortality and recurrence according to various clinicopathological factors were estimated using Cox proportional hazards models.

Results

After a mean follow-up of 4.3 years, 275 (33.3%) TNBC patients had a progression of the disease and 170 (20.2%) died. After allowance for study center, age at diagnosis, and various clinicopathological factors, all components of the TNM staging system were identified as significant independent prognostic factors for TNBC mortality. The HRs were 3.13, 9.65, and 29.0, for stage II, III and IV, respectively, vs stage I. Necrosis and Ki-67 > 16% were also associated with increased mortality (HR: 1.61 and 1.99, respectively). Patients with tumor histotypes other than ductal invasive/lobular carcinomas had a more favorable prognosis (HR: 0.40 vs ductal invasive carcinoma). No significant associations with mortality were found for histologic grade, tumor infiltrating lymphocytes, and lymphovascular invasion. Among lymph node positive TNBCs, lymph node ratio appeared to be a stronger predictor of mortality than pathological lymph nodes stage (HR: 0.80 for pN3 vs pN1, and 3.05 for >0.65 vs <0.21 lymph node ratio), respectively. Consistent results were observed for cancer recurrence, except for Ki-67 and necrosis that were not found to be significant predictors for recurrence.

Conclusions

This uniquely large study of TNBC patients provides further evidence that, besides tumor stage at diagnosis, lymph node ratio among lymph node positive tumors is an additional relevant predictor of survival and tumor recurrence, while Ki-67 seems to be predictive of mortality, but not of recurrence.
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Metadata
Title
Clinical and pathological factors influencing survival in a large cohort of triple-negative breast cancer patients
Authors
Silvana Anna Maria Urru
Silvano Gallus
Cristina Bosetti
Tiziana Moi
Ricardo Medda
Elisabetta Sollai
Alma Murgia
Francesca Sanges
Giovanna Pira
Alessandra Manca
Dolores Palmas
Matteo Floris
Anna Maria Asunis
Francesco Atzori
Ciriaco Carru
Maurizio D’Incalci
Massimo Ghiani
Vincenzo Marras
Daniela Onnis
Maria Cristina Santona
Giuseppina Sarobba
Enrichetta Valle
Luisa Canu
Sergio Cossu
Alessandro Bulfone
Paolo Cossu Rocca
Maria Rosaria De Miglio
Sandra Orrù
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3969-y

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