Vol 26, No 4 (2021)
Research paper
Published online: 2021-03-30

open access

Page views 809
Article views/downloads 519
Get Citation

Connect on Social Media

Connect on Social Media

Prognostic factors for early relapse in non-metastatic triple negative breast cancer — real world data

Rita Félix Soares1, Ana Rita Garcia1, Ana Raquel Monteiro1, Filipa Macedo1, Tatiana Cunha Pereira1, Joana Cunha Carvalho1, António Pêgo1, Mónica Mariano1, Pedro Madeira1, Sara Póvoa1, Sofia Broco1, Teresa Carvalho1, Isabel Pazos1, Gabriela Sousa1
Rep Pract Oncol Radiother 2021;26(4):563-572.


BACKGROUND: Triple negative breast cancer (TNBC) has the worst prognosis amongst all subtypes. Studies have shown that the achievement of pathologic complete response in the breast and axilla correlates with improved survival.

The aim of this study was to identify clinical or pathological features of real-life TNBC patients with a higher risk of early relapse.

MATERIALS AND METHODS: Single-centre retrospective analysis of 127 women with TNBC, stage II-III, submitted to neoadjuvant treatment and surgery between January 2016 and 2020. Multivariate Cox regression analysis for disease free survival (DFS) at 2 years was performed and statistically significant variables were computed into a prognostic model for early relapse.

RESULTS: After 29 months of median follow-up, 105 patients (82.7%) were alive and, in total, 38 patients (29.9%) experienced recurrence. The 2-year DFS was 73% (95% CI: 21.3–22.7). In multivariate analysis, being submitted to neoadjuvant radiotherapy [HR 2.8 (95% CI: 1.2–6.4), p = 0.017] and not achieving pathologic complete response [HR 0.3 (95% CI: 0.1–1.7), p = 0.011] were associated with higher risk of recurrence. In our prognostic model, the presence of at least one of these variables defined a subgroup of patients with a worse 2-year DFS than those without these features (59% vs. 90%, p < 0.001, respectively). 

CONCLUSIONS: In this real-life non-metastatic TNBC cohort, neoadjuvant radiotherapy (performed due to insufficient clinical response to neoadjuvant chemotherapy or significant toxicity) impacted as an independent prognostic factor for relapse along with the absence of pathologic complete response identifying a subgroup of higher risk patients for early relapse that might merit a closer follow-up.

Article available in PDF format

View PDF Download PDF file


  1. Swain S. Triple-Negative Breast Cancer: Metastatic Risk and Role of Platinum Agents 2008 ASCO Clinical Science Symposium, 2008.
  2. The Global Cancer Observatory. https://gco.iarc.fr/.
  3. Lin NU, Vanderplas A, Hughes ME, et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer. 2012; 118(22): 5463–5472.
  4. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010; 28(16): 2784–2795.
  5. Weigelt B, Reis-Filho J. Histological and molecular types of breast cancer: is there a unifying taxonomy? Nat Rev Clin Oncol. 2009; 6(12): 718–730.
  6. Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007; 13(15 Pt 1): 4429–4434.
  7. Cheang MCU, Voduc D, Bajdik C, et al. Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res. 2008; 14(5): 1368–1376.
  8. Hernandez-Aya LF, Chavez-Macgregor M, Lei X, et al. Nodal status and clinical outcomes in a large cohort of patients with triple-negative breast cancer. J Clin Oncol. 2011; 29(19): 2628–2634.
  9. Sørlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001; 98(19): 10869–10874.
  10. Kennecke H, Yerushalmi R, Woods R, et al. Metastatic behavior of breast cancer subtypes. J Clin Oncol. 2010; 28(20): 3271–3277.
  11. Thike AA, Iqbal J, Cheok PY, et al. Triple negative breast cancer: outcome correlation with immunohistochemical detection of basal markers. Am J Surg Pathol. 2010; 34(7): 956–964.
  12. Dent R, Hanna WM, Trudeau M, et al. Pattern of metastatic spread in triple-negative breast cancer. Breast Cancer Res Treat. 2009; 115(2): 423–428.
  13. Liedtke C, Mazouni C, Hess KR, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008; 26(8): 1275–1281.
  14. Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014; 384(9938): 164–172.
  15. Yin L, Shuang H, Sheng C, et al. The Prognostic Value of Nodal Staging in Triple-Negative Breast Cancer - A Cohort from China. Sci Rep. 2018; 8(1): 9007.
  16. Asaga S, Kinoshita T, Hojo T, et al. Prognostic factors for triple-negative breast cancer patients receiving preoperative systemic chemotherapy. Clin Breast Cancer. 2013; 13(1): 40–46.
  17. Wolff AC, Hammond ME, Hicks DG, et al. American Society of Clinical Oncology, College of American Pathologists. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013; 31(31): 3997–4013.
  18. von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012; 30(15): 1796–1804.
  19. Fayanju OM, Ren Yi, Thomas SM, et al. The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg. 2018; 268(4): 591–601.
  20. Mladenovic J, Susnjar S, Tanic M, et al. Tumor response and patient outcome after preoperative radiotherapy in locally advanced noninflammatory breast cancer patients. J Buon. 2017; 22(2): 325–33.
  21. Coelho RC, Da Silva FML, Do Carmo IML, et al. Is there a role for salvage radiotherapy in locally advanced breast cancer refractory to neoadjuvant chemotherapy? Breast. 2017; 31: 192–196.
  22. Foulkes WD, Grainge MJ, Rakha EA, et al. Tumor size is an unreliable predictor of prognosis in basal-like breast cancers and does not correlate closely with lymph node status. Breast Cancer Res Treat. 2009; 117(1): 199–204.
  23. Shibuta K, Ueo H, Furusawa H, et al. The relevance of intrinsic subtype to clinicopathological features and prognosis in 4,266 Japanese women with breast cancer. Breast Cancer. 2011; 18(4): 292–298.
  24. Tun NM, Villani G, Ong K, et al. Risk of having BRCA1 mutation in high-risk women with triple-negative breast cancer: a meta-analysis. Clin Genet. 2014; 85(1): 43–48.

Reports of Practical Oncology and Radiotherapy