title: Failure patterns and survival outcomes in triple negative breast cancer (TNBC): a 15 year comparison of 448 non-Hispanic black and white women.
abstract: OBJECTIVE
  Triple negative breast cancer (TNBC) is a distinct subtype of breast cancer with unique pathologic, molecular and clinical behavior. It occurs more frequently in young blacks and has been reported to have a shorter disease-free interval. We undertook this study to analyze the demographic characteristics, failure patterns, and survival outcomes in this disease.
  
  
  METHODS
  A total of 448 non-Hispanic black and white women were identified over a 15 year period from 1996 to 2011. Demographic and clinical information including age, race, menopausal status, stage, tumor characteristics, and treatments were collected. Fisher's exact test and multivariable Cox regression were used to compare failure patterns and survival outcomes between races.
  
  
  RESULTS
  49 % (n = 223) were black. 59 % patients were between 41 and 60 years, with 18 % ≤40 years. 57 % were premenopausal and 89 % had grade 3 tumors. Stage II (47 %) was most frequent stage at diagnosis followed by stage III (28 %). 32 % had lymphovascular invasion. Adjusting for age, stage, and grade, there was no difference in survival outcomes (OS, DFS, LFFS, and DFFS) between the two races. 62 (14 %) patients failed locally either in ipsilateral breast or chest wall, and 19 (4 %) failed in the regional lymphatics. Lung (18 %) was the most frequent distant failure site with <12 % each failing in brain, liver and bones.
  
  
  CONCLUSIONS
  Failure patterns and survival outcomes did not differ by race in this large collection of TNBC cases. Lung was the predominate site of distant failure followed by brain, bone, and liver. Few patients failed in the regional lymphatics.
authors.affiliation: Department of Internal Medicine, North Shore-Long Island Jewish Medical Center, Manhasset, NY USA.
authors.forename: Shreya
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Center for Health Disparities, Brody School of Medicine, Office of Research, College of Nursing, East Carolina University, Greenville, NC USA.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: James
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Walker
authors.affiliation: Department of Radiation Oncology and Neurosurgery, Cyberknife Radiosurgery Program, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Zagar
authors.affiliation: Department of Radiation Oncology, University Hospitals Sideman Cancer Center, Case Western Reserve University, Cleveland, OH USA.
authors.forename: Tithi
authors.initials: T
authors.lastname: Biswas