Histologic subtyping affecting outcome of triple negative breast cancer: a large Sardinian population-based analysis

• Main Authors: Francesca Sanges, Matteo Floris, Paolo Cossu-Rocca, Maria R. Muroni, Giovanna Pira, Silvana Anna Maria Urru, Renata Barrocu, Silvano Gallus, Cristina Bosetti, Maurizio D’Incalci, Alessandra Manca, Maria Gabriela Uras, Ricardo Medda, Elisabetta Sollai, Alma Murgia, Dolores Palmas, Francesco Atzori, Angelo Zinellu, Francesca Cambosu, Tiziana Moi, Massimo Ghiani, Vincenzo Marras, Maria Cristina Santona, Luisa Canu, Enrichetta Valle, Maria Giuseppina Sarobba, Daniela Onnis, Anna Asunis, Sergio Cossu, Sandra Orrù, Maria Rosaria De Miglio
• Format: Article
• Language: English
• Published: BMC 2020-06-01
• Series: BMC Cancer
• Subjects: Triple negative breast cancer; Clinico-pathological features; Prognosis; Histologic special type; Tumor size; Metastatic lymph node
• Online Access: http://link.springer.com/article/10.1186/s12885-020-06998-9

Abstract Background Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing “special types” to high-grade invasive breast carcinomas of no special type (IBC-NST). Methods This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. Results TNBC “special types” showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. Conclusions Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.