| Objective: The triple negative-breast carcinoma (TNBC) is that the breast cancer which with estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 in immunohistochemistry are negative . A number of studies show that TNBC almost occurs in premenopausal women, TNBC which are stronger in invasive, earlier in recurrence , faster in progress and shorter in disease-free survival than non-TNBC. TNBC metastases commonly in visceral and soft tissue, such as spinal cord, meninges, brain, liver and lung. And the transition probability significantly higher than non-TNBC,up to 4 times,but the incidence of bone metastasis is similar to non-TNBC. It prompts that the transfer and diffusion mechanisms of such breast cancer may be different from other types of breast cancer. Because the TNBC patients lack the expression of ER, PR and Her-2,it is invalid by endocrine and trastuzumab targeted therapy. There is no specific treatment guidelines for TNBC, the chemotherapy is still the main systemic treatment, and the results are unsatisfactory. The individualized treatment plan which is more targeted is still needed to develop for TNBC patients. This study aimed to analyzed retrospectively the clinical and pathological features, survival and prognostic factors of TNBC with multivariate analysis, in order to understand betterly the occurrence and development of TNBC, and provide some help for clinicians to develop more scientific, individualized treatment programs .Method: The data of 2575 cases of breast cancer patients who had received surgery treatment , and confirmed by histopathology, and with complete follow-up in hospital of Hebei Medical University Fourth from January 2005 to December 2008 was collected. in which 259 cases TNBC ER, PR and HER-2 were negative by pathological examination, other 2316 cases were non-TNBC. Clinical data was collected, including age, menopausal status, tumor size, tumor stage, lymph node status, histological grade, vascular tumor thrombus, pathological type, family history, etc. And Excel database was established. The patients were followed up (telephone, out-patient or Letters). In the study Operation time is as the starting point, patient death or last follow-up or lost follow-up as the ending for patients, death due to cancer as the study outcome. The Follow-up deadline was November 30, 2010. During the follow-up ,the petient who died of other causes or lost follow-up or still alive were counted as censored data. The differences of pathological features, recurrence and metastasis, overall and disease-free survival of between TNBC and non-TNBC was retrospective analyzed, the factors which influenced the prognostic of TNBC was analyzed also. SPSS13.0 statistical software was used for statistical analysis . the percentage or median were used to describe the clinical data.χ2 test was used to analyze the clinicopathological characteristics, the Kaplan-Meier method was used to analysis the patients'survival, the log-rank test was used to compare Survival rate, and the cox regression analysis was used to univariate and multivariate analysis , P <0.05 is used as the significance test level.Results:1 There are differences in the tumor size, lymph node status, pathological stage, family history, surgical margin status between TNBC and non-TNBC. But there are no differences in the age, menopausal status, histological grade, pathological type, and treatment of vascular tumor thrombus.2 There are 73 cases (28.2%) who had recurrenced in 259 cases TNBC patients,and 424 patients (18.3%) had recurrenced in 2316 cases of non-TNBC patients.The recurrence rate of TNBC group was higher than non-TNBC group, the difference was statistically significant (p <0.05).There were no significant statistical difference in local recurrence rate, bone and brain metastases in the two groups. But, the metastasis rate of lung and liver in TNBC is high, compared with non-TNBC.there was significant statistical difference.3 The Kaplan-Meier was applied to compare the overall survival rate and disease-free survival rate between TNBC and non-TNBC. The results showed that,the TNBC patients 2,3,5 year overall survival rates were respectively 93.8%, 89.6%, 78.1%. the TNBC 2,3,5 year disease-free survival rates were respectively 83.0%, 75.9%, 67.4%. the non-TNBC group 2,3,5 year overall survival rates were respectively 96.0%, 93.9%, 88.1%. the non-TNBC group 2,3,5 year disease-free survival rates were respectively 88.5%, 84.9%, 76.5%.There were differences in the overall survival rate and disease-free survival rate between the two groups, the TNBC's was significantly lower than the non-TNBC's.4 The univariate analysis was used to analyze the relationship between clinicopathological and patients'prognostic, the results showed that, the patients'overall survival and disease-free survival was related to the pathologic stage.Since pathological stage is decided by the primary tumor size (T) and lymph node status (N), the tumor pathological stage was not included in the multivariate COX regression analysis. The histological grade, vascular tumor thrombus, surgical margin status, lymph node status(N), primary tumor size(T), and surgical procedures were included in the multivariate analysis Cox regression model, the results showed that,the lymph node status(N) was the major factor impacted the TNBC's overall survival, the lymph node status (N) and primary tumor size(T) were the main factors impacted the TNBC's disease-free survival.Conclusion:1 Compared with non-TNBC, TNBC patients were characterized by a larger mass, more positive lymph nodes, stageⅡ,Ⅲas the main in the clinical stage and having family history of breast cancer.2 In the terms of metastasis and recurrence rate, TNBC group was higher than that of non-TNBC,there was statistically significant in difference (p <0.05). In the terms of distant metastasis, there was certain organ tendency for TNBC, lung and liver as the main, there was significant difference compared with non- TNBC. This suggests that the mechanism of TNBC distant metastasis may be different from other types of breast cancer, it is likely to be one of the main reasons in poor prognosis.3 Survival analysis showed that, there were statistically significant in overall survival and disease-free survival rates between TNBC and non-TNBC patients.4 Cox regression multivariate analysis showed that, the lymph node status(N) and the primary tumor size(T) were the two main factors in impacting the overall survival and disease-free survival of TNBC.
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