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Int J Clin Exp Pathol 2013;6(7):1380-1391

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

Jing Zhang, Yahong Wang, Quangui Yin, Wei Zhang, Tongxian Zhang, Yun Niu

Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education and Key Laboratory of Cancer
Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, West Huanhu Road, Ti Yuan Bei, Hexi District,
Tianjin 300060, China; Department of radiotherapy, Tianjin Huanhu Hospital, No. 122, Qixiangtai Road, Hexi District, Tianjin, P. R. 300060,
China; Department of Internal Medicine, WuQing Hospital, Tianjin 301700, China. These authors contributed equally to this work.

Received April 25, 2013; Accepted May 20, 2013; Epub June 15, 2013; Published July 1, 2013

Abstract: 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. (IJCEP1304034).

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

Address correspondence to: Dr. Yun Niu, Key Laboratory of Breast Cancer Prevention and Therapy,  Ministry of Education and Key Laboratory
of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, West Huanhu Road, Ti Yuan Bei, Hexi
District, Tianjin 300060, China. Tel: +86-22-23340123-6006; Fax: +86-22-23340123-6026; E-mail: yunniu2000@126.com