title: Triple-negative breast cancer has worse overall survival and cause-specific survival than non-triple-negative breast cancer.
abstract: The current American Joint Committee on Cancer (AJCC) staging manual uses tumor size, lymph node, and metastatic status to stage breast cancer across different subtypes. We examined the prognosis of triple-negative breast cancer (TNBC) versus non-TNBC within the same stages and sub-stages to evaluate whether TNBC had worse prognosis than non-TNBC.
  
  
  
  We reviewed the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data and identified 158,358 patients diagnosed with breast cancer from 2010 to 2012. The overall survival (OS) time and breast cancer cause-specific survival time were compared between patients with TNBC and non-TNBC in each stage and sub-stages. The results were validated using a dataset of 2049 patients with longer follow-up from our institution.
  
  
  
  Compared with patients with non-TNBC, patients with TNBC had worse OS and breast cancer cause-specific survival time in every stage and sub-stage in univariate and multivariate analyses adjusting for age, race, tumor grade, and surgery and radiation treatments in the SEER data. The worse OS time in patients with TNBC was validated in our institutional dataset.
  
  
  
  Patients with TNBC have worse survival than patients with non-TNBC. The new AJCC staging manual should consider breast cancer biomarker information.
authors.affiliation: Department of Pathology and Laboratory Medicine, Glenn Family Breast Center, Winship Cancer Institute, Emory University, 1364 Clifton Road, Suite H175, Atlanta, GA, 30322, USA. xli40@emory.edu.
authors.forename: Xiaoxian
authors.identifier: 0000-0002-0995-1721
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
authors.forename: Limin
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Aysegul A
authors.initials: AA
authors.lastname: Sahin
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Huo
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Regan
authors.affiliation: Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Mylin A
authors.initials: MA
authors.lastname: Torres
authors.affiliation: Department of Hematology and Medical Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Meisel
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002423:Cause of Death; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D064726:Triple Negative Breast Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D047368:Tumor Burden
keywords: AJCC; Cancer staging; Cause-specific survival; Overall survival; Prognosis; TNBC; Triple-negative breast cancer