Should triple-positive breast cancer be recognized as a distinct subtype?

Dieci, Maria Vittoria; Guarneri, Valentina

doi:10.1080/14737140.2020.1829484

Cited by 21 publications

(23 citation statements)

References 15 publications

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“…As Figure 3 shows, the correction curves of the modeling group and the verification group are close to the ideal 45° dotted line, indicating a good consistency between the predicted value and the actual value (13). A score for each of the clinical pathological features of a TPBC patient can be obtained by projecting the patient's score upwards onto a small scale and summing the scores to obtain a total score, the higher the total score, the worse the survival prognosis, and the lower the OS rate at 3 and 5 years (14).…”

Section: Nomogram Validationmentioning

confidence: 70%

Establishment and verification of a nomogram for predicting survival in patients with triple-positive breast cancer

Wang¹,

Wang²,

Liu³

et al. 2022

Ann Transl Med

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Background: Triple-positive breast cancer (TPBC) is a specific type of breast cancer characterized by the positive expression of estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER-2). In recent years, the research on breast cancer has been increasing year by year, but there are few studies on TPBC, especially the lack of analysis with large sample size. In this study, sufficient samples were provided through the SEER database, explore the factors affecting the prognosis of TPBC, and construct a prediction model, in order to assess the individual survival of patients, and help clinicians accurately identify high-risk patients and develop personalized treatment plans.Methods: Patients pathologically diagnosed with TPBC were recruited from Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation groups (7:3 ratio). Univariate analysis was used to analyze the related factors affecting the prognosis of TPBC patients in the modeling group, and then multivariate Cox proportional hazards model was used to analyze the significant factors to screen out the independent risk factors affecting the 3-and 5-year overall survival (OS) rate and construct the prediction model. Using the concordance index (C-index) and calibration curve were performed to evaluate the predictive ability of the model. Results: The results of the Cox risk-scale model showed that race, age, marital status, tumor grade, tumor, node, metastasis stage, surgical treatment, chemotherapy, and radiotherapy affected the prognosis of TPBC patients (P<0.05) in the training group, and the factors were used to construct a nomogram. The internal and external validation of the nomogram chart indicated that the C-index of the training group was 0.85 [95% confidence interval (CI): 0.836, 0.863] and that of the verification group was 0.833 (95% CI: 0.807, 0.858).The calibration curves of the 2 groups showed that the OS predicted by the model was consistent with the actual survival of the patients. Conclusions:The prediction model accurately predicted the prognosis of and identified high-risk TPBC patients.

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Section: Nomogram Validationmentioning

confidence: 70%

Establishment and verification of a nomogram for predicting survival in patients with triple-positive breast cancer

Wang¹,

Wang²,

Liu³

et al. 2022

Ann Transl Med

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“… 1 , 2 Human epidermal growth factor receptor 2 (HER2) overexpression is reported in ∼15%-20% of primary breast carcinomas and is associated with poor prognosis, and nearly half of HER2-positive breast cancers also express hormone receptors (HRs). 3 , 4 HR-positive/HER2-positive breast cancers are associated with better survival rates than HR-negative/HER2-positive breast cancers. 5 In addition, the majority of estrogen receptor (ER)-positive breast cancers also express progesterone receptor (PR).…”

Section: Introductionmentioning

confidence: 99%

Clinical features of patients with HER2-positive breast cancer and development of a nomogram for predicting survival

Fan

Wang

et al. 2021

ESMO Open

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Background Different estrogen receptor (ER) and progesterone receptor (PR) expression patterns have important biological and therapeutic implications in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, little is known about hormone receptor (HR)-positive and triple-positive subtypes, making therapy selection and survival prognosis difficult. This study investigated the clinical characteristics and nomogram-predicted survival of patients with HER2-positive breast cancer. Materials and methods Data on patients with HER2-positive breast cancer were retrieved from the Surveillance, Epidemiology, and End Results database. Comparisons were carried out between single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram-based model of predicted outcomes was developed. Results This cohort study included 34 819 patients with breast cancer (34 606 women and 213 men). Single HR-positive and double HR-positive/double HR-negative subtypes showed distinct clinicopathological characteristics. Multivariable Cox regression analysis showed that patients with ER-positive/PR-negative/HER2-positive [hazard ratio (HR) = 1.24; 95% confidence interval (CI): 1.14-1.39], ER-negative/PR-positive/HER2-positive (HR = 1.56; 95% CI: 1.23-1.97), and ER-negative/PR-negative/HER2-positive (HR = 1.56; 95% CI: 1.43-1.70) subtypes had worse breast cancer-specific survival than patients with the triple-positive subtype. Thirteen clinical parameters were included as prognostic factors in the nomogram: age, sex, race, grade, histology type, bone, brain, liver, and lung metastasis, TNM (tumor–node–metastasis) staging, and molecular subtype. The C-index was 0.853 (95% CI: 0.845-0.861). Calibration plots indicated that the nomogram-predicted survival was consistent with the recorded 3-year and 5-year prognoses. Conclusions Significant differences in survival rates were observed between single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram accurately predicted survival. Different treatment strategies may be required for HER2-positive patients with single HR-positive and double HR-positive tumors to ensure optimal treatment and benefits.

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“…There is growing evidence that TPBC differs from HER2 overexpressing breast cancer in clinicopathological features, biological behavior, and recurrence patterns. Positive expression of both ER and PR in HER2positive breast cancer patients is associated with a better prognosis, and TPBC breast cancer patients should be considered as a distinct subgroup as well 24 .…”

Section: Discussionmentioning

confidence: 99%

Characterization of 940 Chinese patients with triple-positive breast cancer by clinicopathological and treatment outcomes

Liang

Jia

Zhao

et al. 2022

Preprint

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Background This study aims to evaluate the clinicopathological features, prognosis, and related prognosis factors of triple-positive breast cancer, to develop more scientific and individualized treatment plans. Methods We collected pathological and clinical data from 960 patients with early-stage triple-positive breast cancer who underwent surgical treatment at Tianjin Medical University Cancer Institute and Hospital (2012–2017). The Cox regression model was used for prognostic univariate analysis and multifactor analysis. Kaplan-Meier was used to plot survival curves, and the log-rank test was used to analyze survival differences between groups. Results T-stage, N-stage, whether to receive adjuvant targeted therapy, and whether to receive adjuvant endocrine therapy were independent influencing factors of prognosis (P < 0.05). Subgroup analysis showed that sequential tamoxifen treatment alone in the targeted therapy group did not significantly improve the prognosis of patients (P < 0.05). The benefit of endocrine treatment was not significant in low ER-positive breast cancer (P > 0.05). The prognosis of T1abN0M0 patients was not significantly altered by the use of trastuzumab or not (P = 0.439). There was no significant difference in OS with or without trastuzumab in the HR ≥ 30% group (P = 0.212) and in DFS and OS in the HR ≥ 50% group (P = 0.082, P = 0.978). Conclusions Our findings indicate that HR expression influences the biological behavior and treatment outcome of TPBC. We should choose individualized, targeted treatment programs, based on patients’ HR expression and pathological staging to benefit patients with TPBC.

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Should triple-positive breast cancer be recognized as a distinct subtype?

Cited by 21 publications

References 15 publications

Establishment and verification of a nomogram for predicting survival in patients with triple-positive breast cancer

Establishment and verification of a nomogram for predicting survival in patients with triple-positive breast cancer

Clinical features of patients with HER2-positive breast cancer and development of a nomogram for predicting survival

Characterization of 940 Chinese patients with triple-positive breast cancer by clinicopathological and treatment outcomes

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