| Background and Objective: Tri-negative breast cancer is a relatively special type of breast cancer,it is invasive subtype with unique clinical biological behavior and becomes a difficult point in clinical treatment due to the lack of target(the expression of ER,PR,HER-2).Compared with other subtypes of breast cancer(luminal and positive HER-2),tri-negative breast cancer has poor prognosis.Part of TNBC grows fast,aggressive,resistant to chemotherapy,poor prognosis,while some TNBC has good prognosis.The heterogeneity of the prognosis of tri-negative breast cancer is not clear.This study intends to follow the database of breast surgical breast cancer follow-up cases in our hospital,retrospectively analyze the factors affecting the prognostic heterogeneity of triple negative breast cancer and provide the basis for the in-depth study of tri-negative breast cancer.Contents and Methods: The first part mainly studies the features comparison of TNBC and other subtypes(luminal and positive HER-2)epidemiology,including the comparison of the frequency of occurrence,the age of onset,the rate of the histological grade 1-2 and 3,the clinical stage.The second part is the comparison of OS and DFS between TNBC and other subtypes.In the third part,to comparatively analyze the median survival time,the median age,the histological grade,the clinical stage and the death rate of each features between TNBC and other subtype death cases.The fourth part is to facilitate comparative analysis the median age,tissue classification,clinical stage and lymph node metastasis of TNBC with good prognosis and poor prognosis.The data was collected from the breast cancer follow-up of the breast surgery of the Academy of Military Sciences Affiliated 307 Hospital from August 2006 to December 2015 and it is from 746 patients with breast cancer confirmed by pathology,completed standard surgery for breast cancer and with completed follow-up data.The patients with tri-negative breast cancer were identified as the tri-negative group,and the non-trinegative breast cancer patients were identified as non-tri-negative group.The disease-free patients after 3 years of tri-breast cancer surgery was determined as a good prognosis group,while others with recurrence and metastasis and the death cases were identified as a poor prognosis group.By comparing the epidemiological characteristics,survival situation,analysis of death cases and the clinical features prognosis,retrospectively analyze the factors affecting the prognostic heterogeneity of triple negative breast cancer.The patients were followed up by telephone,letter,outpatient review,etc.The follow-up date is as of October 2017.The follow-up included patient survival,recurrence,metastasis and other related clinical data.Statistical analysis using SPSS 20.0 software.The description of clinicopathologic data is in the form of percentage,by using chi-square test to compare the clinical pathology between the tri-negative group and non-tri-negative group,the survival rate and the survival curve were calculated and plotted by the Kaplan-Meier method.To inspect the comparison of the survival rate between the tri-negative group and non-trinegative group by Log-rank test and while P<0.05 the difference is defined as statistically significant.Results: 1.The comparison of epidemiological characteristics between the tri-negative group and non-tri-negative group.Among the 746 cases of breast cancer,there were 100 patients with triple-negative breast cancer(13.4%),646 patients with non-triple-negative breast cancer(86.6%).(1)The two groups were compared in age,the median age of triplenegative breast cancer was 48,the median age of non-triple-negative breast cancer was 53.The proportion of patients under 35 years old was 12% in the tri-negative group,it was significantly higher than that of the non-tri-negative group(6.7%),the difference was statistically significant(P=0.049);(2)The two groups were compared in histological grade,histological grade III patients in the tri-negative group(55%)were significantly higher than those of the non-tri-negative group(14.6%),the difference was statistically significant(P=0.000);(3)The two groups were compared in clinical stages,the proportion of patients with stage 0+I and II was 83% in the tri-negative group,while the stage III was 17%,the proportion of patients with stage 0+I and II was 87.5% in the non-trinegative group,while the proportion of the stage III was 12.5%.Most patients of the stage 0+I and II,the number of the patients with stage III of the tri-negative group were more than that in the non-tri-negative group,but there was no statistical difference between the two groups(P=0.286).2.The comparison of DFS and OS of 3 years and 5 years between the tri-negative group and the non-tri-negative group.The DFS of 3 years and 5 years of the tri-negative group was 81%?67.1%,which was significantly lower than that of the non-tri-negative group,the differences between the two groups were statistically significant(P=0.002);The OS of 3 years and 5 years of the tri-negative group was 89%?74.4%,which was also significantly lower than that of the non-tri-negative group(93.7%,89.2%),the differences between the two groups were statistically significant(P=0.000).The prognosis of the tri-negative group was relatively poor.3.The analysis of the death cases.A total of 87 patients died,there were 24 patients with triple negative breast cancer,it accounted for 24% of all patients with triple-negative breast cancer,the median age was 53,the median survival time was 38 months;There were 63 patients with triple negative breast cancer,it accounted for 9.8% of all patients with non-triple-negative breast cancer,the median age was 55,the median survival time was 39 months.(1)The comparison of the death cases between the tri-negative group and the non-tri-negative group.In the tri-negative group,the proportion of died patients under 35 years old was 16.7%,which was significantly higher than that of the non-tri-negative group(1.6%),the differences between the two groups were statistically significant(P=0.004).The death rate of all ages groups in the tri-negative group were higher than that in the non-tri-negative group,also the proportion of the death patients under 35 years old(33.3%)in the tri-negative group was significantly higher than that in the non-trinegative group(2.3%),The difference between the two groups was statistically significant(P=0.003);(2)The histological grade and the clinical stage were not statistically significant in the comparison between the tri-negative group and the non-trinegative group(P=0.056?P=0.484),there was no statistically significant difference in death rate(P=0.056,P=0.484).However,in both groups,the proportion of patients with histological grade III(25.5%,23.4%)was higher than that of patients with histological grade I+II(22.2%,7.4%),the proportion of patients with clinical stage III was significantly higher than that in other clinical stages(45.8%,44.4%),also the death rate of the clinical stage III patients(76.5%,43.2%)was significantly higher than those in other clinical stages(25.3%,9.7%).4.The comparison of the clinical features between the good prognosis group and the poor prognosis group of triple negative breast cancer.Among the patients with triplenegative breast cancer,there were 81 cases(81%)had good prognosis,19 cases(19%)had poor prognosis.(1)The comparison of the age between the good prognosis group and the poor prognosis group.In the good prognosis group,the proportion of patients under 35 years old was 9.8%,the proportion of patients between 30 and 50 years old was 38.3%,but the difference was not statistically significant(P=0.306).The rate of recurrence,metastasis and death of patients under 35 years old(33.3%)was significantly higher than those aged between 35 and 50 years old(16.3%)and above(14.3%);(2)The two groups were compared in histological grade,the proportion of histological grade III patients with good prognosis was similar to that of patients with poor prognosis(52.6%),the difference was not statistically significant(P=1.000).In the good prognosis group and the poor prognosis group,the proportion of patients with histological grade III(55.6%,52.6%)was higher than the proportion of patients with histological grade I+II(44.4%,47.4%),the rate of recurrent metastasis and death in histological grade I+II and III respectively was 20%,18.2%;(3)The comparison of clinical stage between the two groups,the proportion of the patients with a good prognosis in the clinical stage III(9.9%)was significantly lower than that with poor prognosis(47.4%),the proportion of the patients with the clinical stage 0+I(42.0%)was significantly higher than that with poor prognosis(5.3%),the difference was statistically significant(P=0.000).The proportion of recurrent metastasis and death in the patients with the clinical stage III(52.9%)was significantly higher than that of patients with the clinical stage 0+I and II(2.9%,18.8%);(4)In this study,the rate of positive lymph node was 55% in the patients with TNBC.The lymph node metastasis were compared among two groups,the proportion of the patients with positive lymph node(48.1%)was significantly lower than that of the poor prognosis group(84.2%),the difference was statistically significant(P=0.005).in addition,the proportion of recurrent metastasis and death of the patients with positive lymph node(29.1%)was significantly higher than that of the patients with negative lymph node(6.7%).Conclusion: In this study,triple negative breast cancer accounted for 13.4% of all types of breast cancer,the median age is 48,the age of onset tends to be younger.Compared to non-triple negative breast cancer,triple negative breast cancer has the characteristics of poor histological grade,late clinical stage,poor prognosis and high rate of death etc.The 3 years,5 years DFS and OS are lower than other types of breast cancer.The age of onset,clinical stage and lymph node metastasis may be the important factors affecting the prognosis heterogeneity of the triple-negative breast cancer. |
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