No Increased Risk of Local Recurrence After Breast-Conserving Surgery in Triple-Negative Breast Cancer in Single-Center Study
Triple-negative breast cancer may be considered a relative contraindication to breast-conserving surgery. In a study reported in JAMA Surgery, Gangi et al from Cedars-Sinai Medical Center in Los Angeles assessed outcomes in a large cohort of women undergoing breast-conserving surgery at their institution. They found that patients with triple-negative breast cancer were not at greater risk of local recurrence compared with patients with luminal A, luminal B, or ERBB2-enriched subtypes. Triple-negative disease was associated with significantly poorer overall survival compared with luminal A and luminal B subtypes.
Study Details
The study was a prospective database review including 1,851 consecutive patients aged 29 to 85 years with stage I to III invasive breast cancer who underwent breast-conserving therapy at Cedars-Sinai Medical Center between January 2000 and May 2012. Among all patients, 234 (12.6%) had triple-negative breast cancer; 1,341 (72.4%) had luminal A subtype, 212 (11.5%) had luminal B subtype, and 64 (3.5%) had ERBB2-enriched subtype. The primary outcome measure was local recurrence.
Compared with all other subtypes, triple-negative breast cancer was associated with younger age at diagnosis (56 vs 60 years, P = .001), larger tumors (median, 2.1 vs 1.8 cm; P < .001; 52% vs 56%–67% T1, P < .001), higher proportion of ductal only histology (93% vs 79%–95%, P < .001), higher pathologic stage (eg, stage II in 42% vs 33%–42%, P < .001), higher tumor grade (eg, 86% vs 22%–83% grade 3, P < .001), and higher proportion of patients receiving adjuvant chemotherapy (86% vs 38%–85%, P < .001).
Local Recurrence
On multivariate analysis adjusting for age, tumor size, stage, and grade, patients with triple-negative breast cancer did not have significantly increased risk of local recurrence at 5 years compared with patients with luminal A (hazard ratio [HR] = 1.4, P = .43), luminal B (HR = 1.6, P = .43), or ERBB2 (HR = 1.1, P = .87) subtypes. Only tumor size was a significant predictor of local recurrence (HR = 4.7, P = .006).
Regional and Distant Recurrence and Survival
Triple-negative breast cancer was not associated with increased risk of regional recurrence at 5 years compared with luminal A (HR = 1.3, P = .68) or luminal B subtypes (HR = 0.4, P = .25) and was associated with reduced risk vs ERBB2 subtype (HR = 0.2, P = .02). Stage II (HR = 5.2, P = .004) and stage III (HR = 8.3, P = .006) vs stage I were associated with increased risk of regional recurrence.
Triple-negative disease was associated with significantly increased risk of distant recurrence at 5 years compared with luminal A subtype (HR = 2.5, P = .001) but not vs luminal B (HR = 1.6, P = .22) or ERBB2 subtypes (HR = 0.8, P = .67). Other significant predictors of distant recurrence were stage III vs I (HR = 5.4, P < .001) and T2 (HR = 3.5, P = .001) and T3 (HR = 5.5, P =.001) vs T1.
Triple-negative breast cancer was associated with significantly poorer 5-year overall survival compared with luminal A (HR = 3.5, P < .001) and luminal B subtypes (HR = 3.7, P = .001) but not vs ERBB2 subtype (HR = 1.3, P = .55). Other significant predictors of poorer survival were age ≥ 50 vs <50 years (HR = 2.2, P = .005), stage III vs I (HR = 2.8, P = .007), and T2 (HR = 1.9, P = .03) and T3 (HR = 4.2, P = .001) vs T1.
The investigators concluded, “Breast-conserving therapy for [triple-negative breast cancer] is not associated with increased local recurrence compared with [non–triple-negative] subtypes. However, the [triple-negative breast cancer] phenotype correlates with worse overall survival. Breast-conserving therapy is appropriate for patients with [triple-negative breast cancer].”
Armando E. Giuliano, MD, of Cedars-Sinai Medical Center, is the corresponding author for the JAMA Surgery article.
The study was supported by Fashion Footwear Charitable Foundation of New York, Inc, Associates for Breast and Prostate Cancer Studies, the Avon Foundation, the Margie and Robert E. Petersen Foundation, and Linda and Jim Lippman. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
