Favorable prognosis in patients with T1a/T1bN0 triple‐negative breast cancers treated with multimodality therapy

• Published in: Cancer Vol. 118; no. 20; pp. 4944 - 4952
• Main Authors: Ho, Alice Y., Gupta, Gaorav, King, Tari A., Perez, Carmen A., Patil, Sujata M., Rogers, Katherine H., Wen, Yong Hannah, Brogi, Edi, Morrow, Monica, Hudis, Clifford A., Traina, Tiffany, McCormick, Beryl, Powell, Simon N., Robson, Mark E.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.10.2012; Wiley-Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; breast cancer; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Breast Neoplasms - therapy; breast‐conserving therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Mastectomy; Medical sciences; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; outcomes; Prognosis; Receptor, ErbB-2 - metabolism; Receptors, Estrogen - metabolism; Receptors, Progesterone - metabolism; Survival Rate; T1a; T1b; T1N0; triple negative; Tumors; Human; Breast disease; Prognosis; T1b; T1a; Breast cancer; Malignant tumor; Mammary gland diseases; Cancerology; Treatment; outcomes; T1NO; triple negative; Mammary gland; breast-conserving therapy; Triple negative breast cancer; Cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.27480

BACKGROUND: The authors evaluated the clinical characteristics, natural history, and outcomes of patients who had ≤1 cm, lymph node‐negative, triple‐negative breast cancer (TNBC). METHODS: After excluding patients who had received neoadjuvant therapy, 1022 patients with TNBC who underwent definitive breast surgery during 1999 to 2006 were identified from an institutional database. In total, 194 who had lymph node‐negative tumors that measured ≤1 cm comprised the study population. Clinical data were ed, and survival outcomes were analyzed. RESULTS: The median follow‐up was 73 months (range, 5‐143 months). The median age at diagnosis was 55.5 years (range, 27‐84 years). Tumor (T) classification was microscopic (T1mic) in 16 patients (8.2%), T1a in 49 patients (25.3%), and T1b in 129 patients (66.5%). Most tumors were poorly differentiated (n = 142; 73%), lacked lymphovascular invasion (n = 170; 87.6%), and were detected by screening (n = 134; 69%). In total, 129 patients (66.5%) underwent breast‐conserving surgery, and 65 patients (33.5%) underwent mastectomy. One hundred thirteen patients (58%) received adjuvant chemotherapy, and 123 patients (63%) received whole‐breast radiation. The patients who received chemotherapy had more adverse clinical and disease features (younger age, T1b tumor, poor tumor grade; all P < .05). Results from testing for the breast cancer (BRCA) susceptibility gene were available for 49 women: 19 women had BRCA1 mutations, 7 women had BRCA2 mutations, and 23 women had no mutations. For the entire group, the 5‐year local recurrence‐free survival rate was 95%, and the 5‐year distant metastasis‐free survival rate was 95%. There was no difference between patients with T1mic/T1a tumors and patients with T1b tumors in the distant recurrence rate (94.5% vs 95.5%, respectively; P = .81) or in the receipt of chemotherapy (95.9% vs 94.5%, respectively; P = .63). CONCLUSIONS: Excellent 5‐year locoregional and distant control rates were achievable in patients with TNBC who had tumors ≤1.0 cm, 58% of whom received chemotherapy. These results identified a group of patients with TNBC who had favorable outcomes after early detection and multimodality treatment. Cancer 2012. © 2012 American Cancer Society. Favorable 5‐year locoregional and distant control rates are achievable in patients with T1bN0 triple‐negative breast cancers, approximately 66% of whom receive chemotherapy. When they receive multimodality therapy, these patients are excellent candidates for breast‐conserving therapy.