Clinicopathological Characteristics and Treatment Strategies of Triple-Negative Breast Cancer Patients With a Survival Longer than 5 Years

Abstract

PurposeTriple-negative breast cancer (TNBC) is characterized by high malignancy and a poor prognosis. Patients with TNBC who survive longer than 5 years represent a unique portion of the population. This study aimed to analyze the clinicopathological features, explore prognostic factors, and evaluate treatment options for these patients.MethodsA total of 24,943 TNBC patients were enrolled from the national Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2016. The patients were divided into three groups: group 1, survival time <3 years; group 2, 3–5 years; and group 3, survival time ≥5 years. The overall survival (OS) and breast cancer cause-specific survival (BCSS) were primarily assessed in this study. A propensity score analysis was used to avoid bias caused by the data selection criteria. We used a Cox hazard ratio analysis to determine prognostic factors, which were selected as nomogram parameters to develop a model for predicting patient survival.ResultsPatients who survived longer than 5 years were more likely to be younger than 55 years, Caucasian, and exhibit a lower AJCC stage, N stage, distant metastasis, lymph node (LN) involvement, and tumor size than those with a shorter survival time (p < 0.05). The multivariable Cox regression analysis showed that age, race, tumor size, LN status, and chemotherapy were independent prognostic factors. Subgroup analyses for patients with tumors ≤20 mm displayed a superior OS and BCSS for breast-conserving surgery (BCS) not treated with a mastectomy. BCS provided at least an equivalent prognosis to a mastectomy in patients with tumors larger than 20 mm. A nomogram with a C-index of 0.776 (95% confidence interval: 0.767–0.785) was developed to predict the 3- and 5-year survival probability for the patients with TNBC.ConclusionA localized surgical approach may represent a superior choice for TNBC patients with a survival time longer than 5 years. Our study indicated that age, race, tumor size, LN status, and chemotherapy were independent prognostic factors. A prognostic nomogram directly quantified patient risk and was better able to predict long-term survival in TNBC patients.