Outcome of triple negative breast cancer: comparison of sporadic and BRCA1-associated cancers.
The majority of breast cancers developing in BRCA1 mutation carriers are triple negative breast cancers (TNBC), an aggressive subtype that accounts for 15-20 % of sporadic breast cancer. We compare the clinical outcome and sites of relapse of TNBC in BRCA1 mutation carriers and non-carriers who received adjuvant chemotherapy. Women with stage I-III TNBC who had BRCA1 testing within 36 months of diagnosis and received adjuvant chemotherapy were identified from clinical databases at two academic institutions. Sites of relapse, freedom from distant metastasis (FFDM), and breast cancer-specific survival (BCSS) were determined. RCA1 carriers (n = 89) were significantly younger at diagnosis (P < 0.0001) than non-carriers (n = 175). FFDM at 5 years was 80.5 % for carriers and 76.9 % for non-carriers; with median follow-up of 55 months, hazard ratio (HR) was 0.90, P = 0.71. Sites of recurrence, including brain, did not differ significantly. BCSS at 5 years was 88.1 % for carriers and 81.4 % for non-carriers; HR 0.60; P = 0.15 at 55 months follow-up. BRCA1 carriers who underwent oophorectomy had a significantly lower rate of death from TNBC, with an adjusted HR of 0.30 (95 % CI 0.10-0.94). Adjusting for age, oophorectomy, and prophylactic mastectomy, BRCA1 mutation status was not an independent predictor of survival (HR 2.1; P = 0.13). BRCA1 mutation carriers with TNBC had similar survival rates and sites of recurrence to non-carriers after treatment with conventional chemotherapy. Carriers who underwent oophorectomy had a significantly lower rate of breast cancer-related death; this finding should be studied further in all women with TNBC.
Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA, ntung@bidmc.harvard.edu.
Nadine
N
Tung
Elizabeth
E
Gaughan
Michele R
MR
Hacker
Larissa J
LJ
Lee
Brian
B
Alexander
Emily
E
Poles
Stuart J
SJ
Schnitt
Judy E
JE
Garber
D000328:Adult; D005260:Female; D019398:Genes, BRCA1; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D012189:Retrospective Studies; D016019:Survival Analysis; D064726:Triple Negative Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy