title: Breast-conserving therapy for triple-negative breast cancer.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Breast-conserving therapy.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gangi
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Alice
authors.initials: A
authors.lastname: Chung
authors.affiliation: Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Douglas Z
authors.initials: DZ
authors.lastname: Liou
authors.affiliation: Department of Health Information, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Trista
authors.initials: T
authors.lastname: Leong
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult