Clinicopathological Features And Prognosis Of Patients With Triple-negative Special Types Of Breast Cancer

Objective: To examine and analyze the clinicopathologic features,treatment and prognosis of different histologic types of triple-negative special types of breast cancer(SBC),and to provide a theoretical support for the clinical treatment of triple negative SBC.Methods: Collecting all the information of 240 patients with triple-negative SBC who were treated at the Tianjin Medical University Cancer Institute and Hospital from January,2011 to December,2014.According to postoperative pathology,240 patients were divided into medullary carcinoma(38 cases),metaplastic carcinoma(84 cases),adenoid cystic carcinoma(19 cases),invasive lobular carcinoma(31 cases),apocrine carcinoma(30 cases),and mixed lobular-ductal carcinoma(38 cases)6 histological types.The clinicopathological features and survival time of patients with different histological types were retrospectively analyzed.And to analyze the effects of different chemotherapy regimens(Anthracycline/ Taxane chemotherapy,Anthracycline + Taxane chemotherapy,Platinum-based chemotherapy,and other chemotherapy)on DFS and OS in patients with different histological types.All patients were treated with surgery and had a clear pathological diagnosis,and the immunohisto-tochemistry(IHC)were used to tested the levels of ER,PR,HER-2,Ki-67,and P53 expressed in tumor surgical specimen.Statistical analysis of the resulting data was performed using SPSS 22.0.The chi-square test was used to compare the clinicopathological data,the Kaplan-Meier method was used to analyze the patient’s survival status,tThe log-rank test was used to test the survival rate.The Cox proportional hazard models was used to analyze the multivariate factors of prognosis.P< 0.05 was considered statistically significant.Results: The histological grade,tumor T stage,lymph node status,Ki-67,chemotherapy and Chemotherapy regimens had a statistical significance among the different histological types(P<0.05).Univariate analysis showed that histological grade,tumor T stage,lymph node status,chemotherapy,Ki-67,histological type and chemotherapy regimen had an effect on 5-year disease-free survival(P<0.05),while histological grade,tumor T stage,lymph node status,chemotherapy,and histological type had an effect on overall survival(P<0.05).The 5-year DFS rates in patients with mixed lobular-ductal carcinoma,metaplastic carcinoma,and invasive lobular carcinoma were 44.6%,52.9%,and 63.2%,respectively,the 5-year DFS for patients with apocrine carcinoma,medullary carcinoma,and adenoid cystic carcinoma were 78.6%,86.8%,100% respectively.The 5-year OS rates of patients with mixed lobular-ductal carcinoma,metaplastic carcinoma,and invasive lobular carcinoma were 65.1%,68.8%,and 75.6%,respectively.The prognosis of patients with apocrine carcinoma,medullary carcinoma,and adenoid cystic carcinoma was better,the 5-year OS rates were 87.6%,89.6%,and 100%,respectively.Multivariate analysis showed that tumor T stage,lymph node status,chemotherapy,and histological type were independent prognostic factors for disease-free survival time and overall survival time.Platinum-based chemotherapy in patients with metaplastic carcinoma(P=0.044)and anthracycline combined with taxane-based chemotherapy in patients with mixed lobular-ductal carcinoma(P=0.008)had longer DFS.Conclusion: Triple-negative special types of breast cancer patients with different histological types have different clinicopathological features and prognosis.The patients with adenoid cystic carcinoma,medullary carcinoma and apocrine carcinoma have a better prognosis,while the patients with metaplastic carcinoma,invasive lobular carcinoma and mixed lobular-ductal carcinoma have a poor prognosis.Patients with metaplastic carcinoma who received platinum-based chemotherapy regimen and patients with mixed lobular-ductal carcinoma who received anthracycline combined with taxane chemotherapy had a better prognosis.It provides a theoretical basis for the clinical diagnosis and treatment of triple-negative metaplastic carcinoma and mixed lobular-ductal carcinoma.