| Objective: To analyze the clinical characteristics of triple-negative breast cancer,explore different treatment methods and their effects on survival,and summarize the factors that may affect the prognosis of triple-negative breast cancer,and provide a basis for individualized diagnosis and treatment of triple-negative breast cancer.Methods: A total of 135 female patients with triple-negative breast cancer who were diagnosed with complete clinical,pathological and follow-up data from January 2010 to December 2015 at the First Affiliated Hospital of Dalian Medical University were enrolled.The clinical characteristics and treatment plan of the 135 patients were summarized,including age of onset,menstrual status at the time of onset,tumor pathological stage,histological grade,vascular tumor thrombus,ki-67 score,p53 status,chemotherapy program and local treatment.To analyze the above factors that may affect the prognosis of patients and explore the correlation between them and the prognosis.Statistical analysis was performed using SPSS 25.0 software.Firstly,the single-factor analysis of the count data was performed by c2 test.The independent prognostic factors of triple-negative breast cancer were further analyzed by binary logistic regression for the statistically significant differences.Survival rate was assessed by Kaplan-Meier method,and statistical significance was tested by Log-rank method.P<0.05 was considered as the difference significance criterion.Results:1.Clinical pathological features: The median age of onset of triple-negative breast cancer in the whole group was 49 years old,and the onset time was before menopause(59.3%).The pathological stage of tumor was stage I-III,115 cases of stage I-II,accounting for 85.2%;Stage III patients had 20 cases,accounting for about 14.8%.The maximum tumor diameter of 93.3% patients was less than or equal to 5cm,and that of 34.8% patients was less than or equal to 2cm.37.0% of the lymph nodes were positive.73.3% of the patients had grade III histopathological grade,13.3% had vascular tumor thrombus.Since no ki-67 results were found in patients before 2012,ki-67 was detected in 65 patients in the whole group,with a range of 5%-95%.Only one patient with ki-67 < 15%,accounting for 1.5%,and only one patient with ki-67 < 15%,accounting for 91.0%.P53 was detected in 63 patients,and p53 positive patients accounting for 73.0%.2.The median follow-up time was 63.8 months.There were 40 relapses and 10 deaths.In this study,the 3-year disease-free and locally relapse-free survival rates were 76.3% and 82.2%,respectively,for whole-stage triple-negative breast cancer.There were 29 cases of local regional recurrence,30 cases of distant metastasis,and 19 cases of local regional recurrence and distant metastasis.Visceral metastasis was more common in patients with distant metastasis,lung,liver and brain metastasis accounted for 73.3%(22 cases),and bone metastasis accounted for 26.7%(8 cases).3.Univariate analysis showed that the factors affecting the disease-free survival rate of patients with triple-negative breast cancer were: tumor pathological stage(P=0.004),tumor T stage(P=0.010),N stage lymph node status(P=0.039),No vascular tumor thrombus(P=0.000),local treatment for patients with T1-2N1M0 was also a factor affecting disease-free survival(P=0.044);factors affecting local recurrence rate in patients with triple-negative breast cancer were: tumor clinical Staging(P=0.032),tumor T stage(P=0.012),and presence or absence of vascular tumor thrombus(P=0.001).4.The relationship between the completion of chemotherapy and the prognosis by single factor analysis was not statistically significant.However,the prognosis of patients who have not received chemotherapy or completed chemotherapy is relatively poor.5.In the subgroup analysis,the T1-2N0M0 patients with breast-conserving combined radiotherapy group compared with the radiotherapy group only had a slight advantage in disease-free survival,and their 3-year disease-free survival rates were 89.5% and 78.7%,respectively(P=0.400),there was no significant difference in local recurrence rate in 3 years,89.5% and 83.6%,respectively(P=0.846).For patients with early triple-negative breast cancer with T1-2N1M0,postoperative radiotherapy can significantly improve no local area.The recurrence rate(P=0.044)had little effect on overall survival(P=0.223).6.Multivariate analysis showed that tumor T stage,lymph node status,and vascular tumor thrombus were independent prognostic factors affecting 3-year disease-free survival of triple-negative breast cancer;T stage and vascular thrombus are independent prognostic factors that affecting 3-year no local recurrence of triple negative breast cancer.Conclusion:1.Triple-negative breast cancer mostly occurs in young premenopausal women,with low proportion of lymph node positive,grade III histopathological classification,high ki-67 expression and high p53 positive rate.2.Triple-negative breast cancer is prone to recurrence and metastasis.Distant metastatic organs tend to be more obvious,lung,liver,brain and other common,relatively less bone metastasis.3.The pathological staging of the tumor,T staging of the tumor,vascular thrombus and local treatment are of great significance for the prognosis of triple-negative breast cancer.4.The tumor T stage,lymph node status,and vascular tumor thrombus were independent prognostic factors affecting 3-year disease-free survival of triple-negative breast cancer;T stage and vascular thrombus are independent prognostic factors that affecting 3-year no local recurrence of triple negative breast cancer.5.For patients with stage T1-2N0M0 triple negative breast cancer,there was a slight advantage in disease-free survival(DFS)between the group receiving radiotherapy combined with breast conserving surgery and the group receiving Radical mastectomy alone.6.For patients with stage T1-2N1M0 triple-negative breast cancer,who receiving Radical mastectomy,postoperative radiotherapy can significantly improve the rate of no local regional recurrence(LRFS),but has little effect on the overall survival(OS) rate. |
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