An associated classification of triple negative breast cancer: the risk of relapse and the response to chemotherapy

Int J Clin Exp Pathol. 2013 Jun 15;6(7):1380-91. Print 2013.


Background: Triple negative breast cancer (TNBC) is heterogeneous and considered as an aggressive tumor. This study was to evaluate the associated classification and its correlations with prognosis and the response to chemotherapy in Chinese women.

Methods: Four hundred and twenty-eight cases of invasive TNBC were involved in this study. The expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), and cytokeratin 5/6 (CK5/6), Ki67 and p53 were analyzed by immunohistochemistry and compared with patient outcome, and its implications and chemotherapy response were evaluated in four subgroups: typical medullary carcinoma (TMC), atypical medullary carcinoma (AMC), non-specific invasive ductal carcinoma (IDC) and other types.

Results: The factors of tumor grade, tumor stage, lymph node status, EGFR/CK5/6 status and p53 labeling index were different among the groups. TMC tumors had the lowest rate of relapse (5.8%), while AMC, IDC and other types were associated with an increased risk of relapse (19.1%, 26.7% and 38.2% respectively). Many factors were risk predictors of relapse for TNBC and IDC, while only positive lymph node was for AMC. For MC tumors, adjunctive chemotherapy decreased the risk of relapse in lymph node positive subgroup (36.8% and 66.7%), while not significant in lymph node negative one (8.1% and 10.0%).

Conclusion: The classification based on histologic and IHC findings may be a significant improvement in predicting outcome in TNBC. The different chemotherapy response in subgroups may contribute to guiding the treatment of TNBC.

Keywords: Triple negative breast cancer; atypical medullary carcinoma; chemotherapy; relapse; typical medullary carcinoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Biomarkers, Tumor / analysis
  • Carcinoma, Ductal, Breast / chemistry
  • Carcinoma, Ductal, Breast / classification*
  • Carcinoma, Ductal, Breast / drug therapy*
  • Carcinoma, Ductal, Breast / secondary
  • Carcinoma, Medullary / chemistry
  • Carcinoma, Medullary / classification*
  • Carcinoma, Medullary / drug therapy*
  • Carcinoma, Medullary / secondary
  • Chi-Square Distribution
  • China
  • Disease-Free Survival
  • Female
  • Humans
  • Immunohistochemistry
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local*
  • Neoplasm Staging
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Triple Negative Breast Neoplasms / chemistry
  • Triple Negative Breast Neoplasms / classification*
  • Triple Negative Breast Neoplasms / drug therapy*
  • Triple Negative Breast Neoplasms / pathology


  • Antineoplastic Agents
  • Biomarkers, Tumor