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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Cancer 1/2018

Clinical and pathological factors influencing survival in a large cohort of triple-negative breast cancer patients

BMC Cancer > Ausgabe 1/2018
Silvana Anna Maria Urru, Silvano Gallus, Cristina Bosetti, Tiziana Moi, Ricardo Medda, Elisabetta Sollai, Alma Murgia, Francesca Sanges, Giovanna Pira, Alessandra Manca, Dolores Palmas, Matteo Floris, Anna Maria Asunis, Francesco Atzori, Ciriaco Carru, Maurizio D’Incalci, Massimo Ghiani, Vincenzo Marras, Daniela Onnis, Maria Cristina Santona, Giuseppina Sarobba, Enrichetta Valle, Luisa Canu, Sergio Cossu, Alessandro Bulfone, Paolo Cossu Rocca, Maria Rosaria De Miglio, Sandra Orrù
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12885-017-3969-y) contains supplementary material, which is available to authorized users.



To provide further information on the clinical and pathological prognostic factors in triple-negative breast cancer (TNBC), for which limited and inconsistent data are available.


Pathological characteristics and clinical records of 841 TNBCs diagnosed between 1994 and 2015 in four major oncologic centers from Sardinia, Italy, were reviewed. Multivariate hazard ratios (HRs) for mortality and recurrence according to various clinicopathological factors were estimated using Cox proportional hazards models.


After a mean follow-up of 4.3 years, 275 (33.3%) TNBC patients had a progression of the disease and 170 (20.2%) died. After allowance for study center, age at diagnosis, and various clinicopathological factors, all components of the TNM staging system were identified as significant independent prognostic factors for TNBC mortality. The HRs were 3.13, 9.65, and 29.0, for stage II, III and IV, respectively, vs stage I. Necrosis and Ki-67 > 16% were also associated with increased mortality (HR: 1.61 and 1.99, respectively). Patients with tumor histotypes other than ductal invasive/lobular carcinomas had a more favorable prognosis (HR: 0.40 vs ductal invasive carcinoma). No significant associations with mortality were found for histologic grade, tumor infiltrating lymphocytes, and lymphovascular invasion. Among lymph node positive TNBCs, lymph node ratio appeared to be a stronger predictor of mortality than pathological lymph nodes stage (HR: 0.80 for pN3 vs pN1, and 3.05 for >0.65 vs <0.21 lymph node ratio), respectively. Consistent results were observed for cancer recurrence, except for Ki-67 and necrosis that were not found to be significant predictors for recurrence.


This uniquely large study of TNBC patients provides further evidence that, besides tumor stage at diagnosis, lymph node ratio among lymph node positive tumors is an additional relevant predictor of survival and tumor recurrence, while Ki-67 seems to be predictive of mortality, but not of recurrence.
Additional file 1: Table S1. Hazard ratios (HRs) of recurrence, and corresponding 95% confidence intervals (CIs), according to selected clinical and pathological characteristics, among 825 triple-negative breast cancers (TNBCs). Sardinia, Italy 1994-2015. Table S2. Hazard ratios (HRs) of recurrence, and corresponding 95% confidence intervals (CIs), according to pathological lymph nodes and lymph node ratio among 311 triple-negative breast cancers (TNBCs) with positive lymph nodes. Sardinia, Italy 1994-2015. Figure S1. Kaplan-Meir curves for disease-free survival according to tumor stage among 825 triple-negative breast cancer patients. Sardinia, Italy 1994–2005. Figure S2. Kaplan-Meir curves for disease-free survival according to pathological lymph nodes stage (a) and lymph node ratio (b) among 311 triple-negative breast cancer patients with positive lymph nodes. Sardinia, Italy 1994–2005 (DOC 658 kb)
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