title: Risk of regional recurrence in triple-negative breast cancer patients: a Dutch cohort study.
abstract: Triple-negative breast cancer is associated with early recurrence and low survival rates. Several trials investigate the safety of a more conservative approach of axillary treatment in clinically T1-2N0 breast cancer. Triple-negative breast cancer comprises only 15 % of newly diagnosed breast cancers, which might result in insufficient power for representative results for this subgroup. We aimed to provide a nationwide overview on the occurrence of (regional) recurrences in triple-negative breast cancer patients with a clinically T1-2N0 status. For this cohort study, 2548 women diagnosed between 2005 and 2008 with clinically T1-2N0 triple-negative breast cancer were selected from the Netherlands Cancer Registry. Follow-up data until 2014 were analyzed using Kaplan-Meier. Sentinel lymph node biopsy was performed in 2486 patients, and (completion) axillary lymph node dissection in 562 patients. Final pathologic nodal status was pN0 in 78.5 %, pN1mi in 4.5 %, pN1 in 12.3 %, pN2-3 in 3.6 %, and pNx in 1.1 %. During a follow-up of 5 years, regional recurrence occurred in 2.9 %, local recurrence in 4.2 % and distant recurrence in 12.2 %. Five-year disease-free survival was 78.7 %, distant disease-free survival 80.5 %, and 5-year overall survival 82.3 %. Triple-negative clinically T1-2N0 breast cancer patients rarely develop a regional recurrence. Their disease-free survival is more threatened by distant recurrence, affecting their overall survival. Consequently, it seems justified to include triple-negative breast cancer patients in randomized controlled trials investigating the safety of minimizing axillary staging and treatment.
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. lorivanroozendaal@gmail.com.|GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. lorivanroozendaal@gmail.com.
authors.forename: Lori M
authors.identifier: http://orcid.org/0000-0003-4831-1679
authors.initials: LM
authors.lastname: van Roozendaal
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.|GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Leonie H M
authors.initials: LHM
authors.lastname: Smit
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Gaston H N M
authors.initials: GHNM
authors.lastname: Duijsens
authors.affiliation: Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands.|GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: de Vries
authors.affiliation: Department of Registration and Research, Comprehensive Cancer Organisation the Netherlands, Utrecht, The Netherlands.|Department of Health Technology and Services Research, MIRA Institute for Technical Medicine and Biomedical Technology, University of Twente, Twente, The Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: Siesling
authors.affiliation: Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marc B I
authors.initials: MBI
authors.lastname: Lobbes
authors.affiliation: Devision of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.|GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Maaike
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Johannes H W
authors.initials: JHW
authors.lastname: de Wilt
authors.affiliation: Department of Surgical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.|GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marjolein L
authors.initials: ML
authors.lastname: Smidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009426:Netherlands; D012042:Registries; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data; D016019:Survival Analysis; D064726:Triple Negative Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
keywords: Axillary lymph node dissection; Breast neoplasms; Follow-up; Recurrence; Sentinel lymph node biopsy; Triple-negative breast cancer