Breast-Conserving Therapy for Triple-Negative Breast Cancer | Breast Cancer | JAMA Surgery | JAMA Network
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1.
Wiechmann  L, Sampson  M, Stempel  M,  et al.  Presenting features of breast cancer differ by molecular subtype.  Ann Surg Oncol. 2009;16(10):2705-2710.PubMedGoogle ScholarCrossref
2.
Perou  CM.  Molecular stratification of triple-negative breast cancers.  Oncologist. 2011;16(suppl 1):61-70.PubMedGoogle ScholarCrossref
3.
Sørlie  T, Wang  Y, Xiao  C,  et al.  Distinct molecular mechanisms underlying clinically relevant subtypes of breast cancer: gene expression analyses across three different platforms.  BMC Genomics. 2006;7:127. doi:10.1186/1471-2164-7-127.PubMedGoogle ScholarCrossref
4.
Brenton  JD, Aparicio  SA, Caldas  C.  Molecular profiling of breast cancer: portraits but not physiognomy.  Breast Cancer Res. 2001;3(2):77-80.PubMedGoogle ScholarCrossref
5.
Rakha  EA, Reis-Filho  JS, Ellis  IO.  Impact of basal-like breast carcinoma determination for a more specific therapy.  Pathobiology. 2008;75(2):95-103.PubMedGoogle ScholarCrossref
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.PubMedGoogle ScholarCrossref
7.
Montagna  E, Maisonneuve  P, Rotmensz  N,  et al.  Heterogeneity of triple-negative breast cancer: histologic subtyping to inform the outcome.  Clin Breast Cancer. 2013;13(1):31-39.PubMedGoogle ScholarCrossref
8.
Fisher  B, Anderson  S, Bryant  J,  et al.  Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.  N Engl J Med. 2002;347(16):1233-1241.PubMedGoogle ScholarCrossref
9.
Nguyen  PL, Taghian  AG, Katz  MS,  et al.  Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy.  J Clin Oncol. 2008;26(14):2373-2378.PubMedGoogle ScholarCrossref
10.
Panoff  JE, Hurley  J, Takita  C,  et al.  Risk of locoregional recurrence by receptor status in breast cancer patients receiving modern systemic therapy and post-mastectomy radiation.  Breast Cancer Res Treat. 2011;128(3):899-906.PubMedGoogle ScholarCrossref
11.
Zaky  SS, Lund  M, May  KA,  et al.  The negative effect of triple-negative breast cancer on outcome after breast-conserving therapy.  Ann Surg Oncol. 2011;18(10):2858-2865.PubMedGoogle ScholarCrossref
12.
Meyers  MO, Klauber-Demore  N, Ollila  DW,  et al.  Impact of breast cancer molecular subtypes on locoregional recurrence in patients treated with neoadjuvant chemotherapy for locally advanced breast cancer.  Ann Surg Oncol. 2011;18(10):2851-2857.PubMedGoogle ScholarCrossref
13.
Foulkes  WD, Smith  IE, Reis-Filho  JS.  Triple-negative breast cancer.  N Engl J Med. 2010;363(20):1938-1948.PubMedGoogle ScholarCrossref
14.
Gabos  Z, Thoms  J, Ghosh  S,  et al.  The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer.  Breast Cancer Res Treat. 2010;124(1):187-194.PubMedGoogle ScholarCrossref
15.
Zhang  P, Xu  BH, Ma  F,  et al.  Treatment outcomes and clinicopathologic characteristics of advanced triple-negative breast cancer patients [in Chinese].  Zhonghua Zhong Liu Za Zhi. 2011;33(5):381-384.PubMedGoogle Scholar
16.
Hattangadi-Gluth  JA, Wo  JY, Nguyen  PL,  et al.  Basal subtype of invasive breast cancer is associated with a higher risk of true recurrence after conventional breast-conserving therapy.  Int J Radiat Oncol Biol Phys. 2012;82(3):1185-1191.PubMedGoogle ScholarCrossref
17.
Fulford  LG, Reis-Filho  JS, Ryder  K,  et al.  Basal-like grade III invasive ductal carcinoma of the breast: patterns of metastasis and long-term survival.  Breast Cancer Res. 2007;9(1):R4. doi:10.1186/bcr1636.PubMedGoogle ScholarCrossref
18.
Toft  DJ, Cryns  VL.  Minireview: basal-like breast cancer: from molecular profiles to targeted therapies.  Mol Endocrinol. 2011;25(2):199-211.PubMedGoogle ScholarCrossref
19.
Lowery  AJ, Kell  MR, Glynn  RW, Kerin  MJ, Sweeney  KJ.  Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype.  Breast Cancer Res Treat. 2012;133(3):831-841.PubMedGoogle ScholarCrossref
20.
Solin  LJ, Hwang  W-T, Vapiwala  N.  Outcome after breast conservation treatment with radiation for women with triple-negative early-stage invasive breast carcinoma.  Clin Breast Cancer. 2009;9(2):96-100.PubMedGoogle ScholarCrossref
21.
Montagna  E, Bagnardi  V, Rotmensz  N,  et al.  Breast cancer subtypes and outcome after local and regional relapse.  Ann Oncol. 2012;23(2):324-331.PubMedGoogle ScholarCrossref
22.
Arvold  ND, Taghian  AG, Niemierko  A,  et al.  Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy.  J Clin Oncol. 2011;29(29):3885-3891.PubMedGoogle ScholarCrossref
23.
Haffty  BG, Yang  Q, Reiss  M,  et al.  Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer.  J Clin Oncol. 2006;24(36):5652-5657.PubMedGoogle ScholarCrossref
24.
Freedman  GM, Anderson  PR, Li  T, Nicolaou  N.  Locoregional recurrence of triple-negative breast cancer after breast-conserving surgery and radiation.  Cancer. 2009;115(5):946-951.PubMedGoogle ScholarCrossref
Original Investigation
Pacific Coast Surgical Association
March 2014

Breast-Conserving Therapy for Triple-Negative Breast Cancer

Author Affiliations
  • 1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
  • 2Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California
  • 3Department of Health Information, Cedars-Sinai Medical Center, Los Angeles, California
JAMA Surg. 2014;149(3):252-258. doi:10.1001/jamasurg.2013.3037
Abstract

Importance  The aggressive triple-negative phenotype of breast cancer (negative for estrogen and progesterone receptors and v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2 [ERBB2] [formerly human epidermal growth factor receptor 2 (HER2)]) is considered by some investigators to be a relative contraindication to breast-conserving therapy.

Objectives  To compare outcomes of breast-conserving therapy for patients with triple-negative breast cancer (TNBC) with those of patients with the luminal A, luminal B, and ERBB2 subtypes.

Design, Setting, and Participants  Prospective database review at an academic tertiary medical center with a designated breast cancer center. We included 1851 consecutive patients ages 29 to 85 years with stages I to III invasive breast cancer who underwent breast-conserving therapy at a single institution from January 1, 2000, through May 30, 2012. Of these patients, 234 (12.6%) had TNBC; 1341 (72.4%), luminal A subtype; 212 (11.5%), luminal B subtype; and 64 (3.5%), ERBB2-enriched subtype.

Exposure  Breast-conserving therapy.

Main Outcomes and Measures  The primary outcome measure was local recurrence (LR). Secondary outcome measures included regional recurrence, distant recurrence, and overall survival.

Results  Triple-negative breast cancer was associated with younger age at diagnosis (56 vs 60 years; P = .001), larger tumors (2.1 vs 1.8 cm; P < .001), more stage II vs I cancer (42.1% vs 33.6%; P = .005), and more G3 tumors (86.4% vs 28.4%; P < .001) compared with the non-TNBC subtypes. Multivariable analysis showed that TNBC did not have a significantly increased risk of LR compared with the luminal A (hazard ratio, 1.4 [95% CI, 0.6-3.3]; P = .43), luminal B (1.6 [0.5-5.2]; P = .43), and ERBB2 (1.1 [0.2-5.2]; P = .87) subtypes. Only tumor size was a significant predictor of LR (hazard ratio, 4.7 [95% CI, 1.6-14.3]; P = .006). Predictors of worse overall survival included tumor size, grade, and stage and TNBC subtype.

Conclusions and Relevance  Breast-conserving therapy for TNBC is not associated with increased LR compared with non-TNBC subtypes. However, the TNBC phenotype correlates with worse overall survival. Breast-conserving therapy is appropriate for patients with TNBC.

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