Triple negative breast cancer in Moroccan women: clinicopathological and therapeutic study at the National Institute of Oncology

Abstract

BackgroundTriple-negative breast cancer (TNBC) is defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. This is an aggressive malignancy with a poor prognosis despite the high rates of response to chemotherapy. The aim of this study is to determine the clinicopathological, therapeutic features and outcomes associated with this type of breast cancer.MethodsThis is a retrospective study of confirmed triple negative breast cancer females collected at the National institute of oncology of Rabat in Morocco, between January 2007 and December 2008. Epidemiological, clinical, histological, therapeutic and evolutive data were analyzed. OS and DFS rates were estimated by Kaplan-Meier analysis.ResultsA total of one 152 patients with breast cancer, were identified as having triple-negative breast cancer (16,5%). The median age at diagnosis was 46 years. 130 patients (86%) had infiltrating ductal carcinoma and thirteen had medullar carcinoma (9%). 84 cases (55%) were grade III Scarff-Bloom-Richardson (SBR). 48 % had positive lymph nodes, and 5 % had distant metastases at diagnosis. According TNM staging, 12 patients (8%) had stage I, 90 patients (60%) had stage II and the 43(28%) had stage III. 145 patients received surgery. 41 (28%) had conservative surgery and 104 (72%) received radical mastectomy with axillary lymph nodes dissection. 14 patients with advanced tumors or inflammatory breast cancer have received neoadjuvant chemotherapy and four patients (28%) had complete pathologic response. From 131 patients how received adjuvant chemotherapy, 99 patients (75,5%) had Anthracycline based chemotherapy) and 27 patients (20,6%) had sequential Anthracycline and docetaxel,. Seven patients with metastatic disease received anthracycline-based regimen in the first line metastatic chemotherapy. The median follow-up time was 46 months (range 6,1 -60 months). Overall survival at 5 years for all patients was 76,5%.ConclusionThese results suggest that most TNBC characteristics in Moroccan patients are in accordance with literature data, especially concerning young age at diagnosis high grade tumors, advanced stage at diagnosis, and short time to relapse. Although the high response rate to chemotherapy, the overall prognosis of this subset of tumors remains poor.

Triple negative breast cancer in North of Morocco: clinicopathologic and prognostic features

“…Triple negative breast cancer frequency reported in the present work (17.6 %) is consistent with national [ 14 , 15 ] and international data [ 2 – 4 ]. This frequency varies according to race/ethnicity and positivity threshold set out for HR and HER2 expression [ 2 , 16 , 17 ].…”

Clinical characteristics of triple negative breast cancer in Egyptian women: a hospital-based experience

“…In our study, a positive family history was documented in 7% of patients. Similar incidence of less than 10% was found by Rais et al 13 Higher incidence of positive family history was documented by other studies, both Kwan et al, and Fayaz et al 20,25 20% and 28% in Phipps et al 26 The histological characteristics in this current study showed that invasive ductal carcinoma represented 93.3% in accordance with 90% in many studies. [27][28][29][30][31][32] Invasive ductal carcinoma was most predominant in Singapore and Japan (93% and 95%, respectively).…”

“…18, 39 Our analysis found that stages 0 -I represented 45% while stages III and IV represented 52.5%. This is comparable to some publications, which reported 34% stage III vs. 15% stage I in a study by Pogoda et al 40 , 8% stage I vs. 28% stage III in a study by Rais et al 13 Fayaz et al 25 reported 56% of patients with stages, I and II while stage III represented 37 %. Stark et al 41 , studied a series of 1236 patients with invasive ductal carcinoma, they concluded that women with stages III and IV were 16 times more likely to have triple -negative tumors than those with early stages A much lower incidence of positive lymph nodes was detected in Japanese patients by Ishikawa et al 33 In the current study, positive lymph node was 66% possibly due to the tendency to late presentation of patients in the social stratum that we treat at our center.…”

Breast Cancer in Morocco: A Literature Review

“…In Morocco two studies (Table 1) have explored the prevalence of Triple Negative Breast Cancer cases. In these studies, TNBC represent 17.5% and 16.5% of total breast cancer cases (Akasbi et al, 2011;Rais et al, 2012). These frequencies are in agreement with published data around the world with TNBC accounting for some 10-17% of all breast cancers (Foulkes et al, 2010).…”