The Prognostic Factors Influencing the Outcomes in Patients with Triple Negative Breast Cancer

Introduction: Triple-negative breast cancer (TNBC) accounts for
approximately 10% -- 17% of all breast cancer and characterized by a high
proliferation rate and increased aggressiveness compared with other subtypes.
Surgical intervention is a key component in the treatment of breast cancer.
Cytotoxic chemotherapy represents the mainstay treatment and radiotherapy is a
well established modality to improve loco regional control after surgery with
positive impact on long-term survival in high-risk patients. In the literature,
some prognostic factors reported to be associated with poor outcome in TNBC
while others are not.
Aim of the study: Is to analyze the various clinico pathological prognostic
factors associated with reduction in overall survival and disease recurrence free
survival in these patients.
Patients and methods: This is a retrospective study enrolled patients received
treatment and / or follow up in Sohag University Hospital, Egypt between 2019
and 2024 by surgery, chemotherapy and radiotherapy.
Results: The study enrolled 111 female patients both pre and post menopausal
(55, and 56 respectively). The median age was at 48 yr. During follow up (mean
at 30.8 m) disease recurrences and deaths were reported in 30 (28%) and 17
(15%) respectively with median times at 21.50 and 28 m respectively. A
subgroup comprising only the patients treated with surgery, chemotherapy and
radiotherapy (61 patients) was analyzed. In the whole cohort, disease recurrence
free survival was significantly worse with neo adjuvant chemotherapy,
advanced stage, multi focality of cancer lesions, presence of > 5 axillary lymph
nodes pathologically infiltrated, extra capsular extension, peri neural infiltration,
lympho vascular invasion, and level of Ki-67 labelling index ≤ 40% with p
values at 0.012, 0.000, 0.003, 0.003, 0.016, 0.042 and 0.038 respectively while
in the tri modality subgroup, a significantly worse outcome was associated with
modified radical mastectomy, advanced stage, multi focality of lesions, and ki-
67 labelling index ≤ 40% with p values at 0.013, 0.001, 0.000 and 0.011
respectively. On the level of overall survival, a significantly worse result in the
whole cohort was associated with neo adjuvant chemotherapy, modified radical
mastectomy, advanced stage, multi focality of cancer lesions, maximum tumor
dimension > 4 cm, presence of > 5 axillary lymph nodes pathologically
infiltrated, extra capsular extension and, peri neural infiltration with p values at
0.012, 0.016, 0.001, 0.024, 0.023, 0.001, 0.010 and 0.043 respectively. In the tri
modality subgroup, a significantly worse results were associated with neo
adjuvant chemotherapy, modified radical mastectomy, advanced stage and multi
focality of lesions with p values at 0.040, 0.026, 0.025, 0.001 respectively.
Conclusions: This study provides further information on the relevance of
chemotherapy timing, type of mastectomy, stage of the disease, multi focality of
lesions, extra capsular extension, peri neural infiltration, peri vascular invasion,
size of primary tumor and number of infiltrated lymph nodes as good predictors
of survival and recurrence in triple negative breast cancer