Triple-Negative Breast Cancer Survival in Iranian Patients

  • Mahdi Aghili Department of Radiation Oncology, Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Marzieh Lashkari Mail Department of Radiation Oncology, Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Amir Hosein Farrokhpey Department of General Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Shahrzad Izadi Department of Surgery, Zanjan University of Medical Sciences, Zanjan, Iran.
Breast cancer, Iran, Survival, Triple negative


This study focused on triple-negative breast cancer (TNBC) that is characterized by the lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). The primary goal of this study was to describe the relation between triple-negative receptor status and survival. This is the first study about triple-negative breast cancer in our community of the 1541 patients diagnosed with breast cancer between 2002 and 2007 at the Cancer Institute (Tehran, Iran). 107 patients were identified as TNBC and 107 patients were randomly selected as non-TNB. HER-2, ER and PR status were assessed by immunohistochemistry (IHC). Analyses of their collected data were performed retrospectively and then clinical and pathologic parameters were compared between two groups. In multivariate analysis, a significantly decreased overall survival was observed for patients with TNBC compared with non-TNBC (55.7 months versus 60.7 mounts; 95%CI: 51.1-60.3 and 57.9-63.5 for TNBC and non-TNBC respectively, P=0.0008). The 2- and 5-year estimates for overall survival were 69.8% and 62.3% for TNBC, and 90% and 83% for non-TNBC, respectively. During the study period, 36 (33.6%) patient of TNBC and 14 (13.1%) of non-TNBC presented local recurrence. Significantly decreased disease-free survival was also observed for patients with TNBC compared with non-TNBC (P=0.0004). The 2- and 5-year estimates for disease-free survival were 68% and 63% for TNBC; and 89% and 82% for non-TNBC, respectively. Significantly decreased distant metastasis free survival was also observed for patients with TNBC compared with non-TNBC (54.4 mounts versus 61.7 mounts; 95%CI: 49.8-59.0 and 59.1-64.4 for TNBC and non-TNBC respectively, P=0.0004). Triple negative breast cancer has a biologic aggressive behavior and poor prognosis. Therefore aggressive treatment and regular follow-up in early stage of diagnosis can be a significant impact on their prognosis.


Brenton JD, Carey LA, Ahmed AA, et al. Molecular classification and molecular forecasting of breast cancer: ready for clinical application?.J Clin Oncol 2005;23:7350-60.

Elston CW, Ellis IO, Pinder SE. Pathological prognostic factors in breast cancer. Crit Reu Oncol Hematol 1999;31(3):209-23.

Soerjomataram I, Louwman MW, Ribot JG, Roukema JA, Coebergh JW. An overview of prognostic factors for long term survivors of breast cancer. Breast Cancer Res Treat 2008;107(3):309-30.

Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006;24:2137-50.

Peto R, Boreham J, Clarke M, Davies C, Beral V. UK and USA Breast cancer deaths down 25% in year 2000 at age 20-69 years. Lancet 2000;355(9217):1822.

Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarkem L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005;353(17):1784-92.

Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, Kamby C, Kjaer M, Gadeberg CC, Rasmussen BB, Blichert-Toft M, Mouridsen HT. Postoperative radiotherapy in high risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish breast cancer cooperative group DBCG 82c randomized trial. Lancet 1999;353(9165):1641-8.

Early Breast Cancer Triatist’s Collaborative Group(EBCTCG). Effect of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: and overview of randomized trials. Lancet 2005;365:1687-717.

Liedtke C, Mazouni C, R. Hess K, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol 2008;28:1275-81.

Kim MJ, Ro JY, Ahn SH, Kim HH, Kim SB, Gong G. clinicopathologic significance of the basal-like subtype of breast cancer :a comparison with hormone receptor and HER2/neu overexpressing phenotypes. Hum Pathol 2006;37(9):1217-26.

Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z, Hernandez-Boussard T, Livasy C, Cowan D, Dressler L, Akslen LA, Ragaz J, Gown AM, Gilks CB, van de Rijn M, Perou CM. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res 2004;10(16):5367-74.

Baur KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, Progestrone receptor (PR) –negative, and HER2- negative invasive breast cancer ,the so called triple-negative phenotype: a population-based study from the California cancer registry. Cancer 2007;109(9):1721-8.

Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, Fluge O, Pergamenschikov A, Williams C, Zhu SX, Lønning PE, Børresen-Dale AL, Brown PO, Botstein D. Molecular portraits of human breast tumors. Nature 2000;406(6797):747-52.

Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S,mJohnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Lønning PE, Børresen-Dale AL. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001;98(19):10869-74.

Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, Demeter J, Perou CM, Lønning PE, Brown PO, Børresen-Dale AL, Botstein D. Repeated observation of breast cancer subtypes in independent gene expression data sets.Proc Natl AcadnSci USA 2003;100(14):8418-23.

Sotiriou C, Neo SY, Mc Shane LM, Korn EL, Long PM, Jazaeri A, Martiat P, Fox SB, Harris AL, Liu ET. Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Pre Natl Acad Sci USA 2003;100(18):10393-8.

Stead Lesley A, Lash Timothy L, Sobieraj Jerome E, Dorcas D Chi, Jennifer L Westrup, Marjory Charlot, Rita A Blanchard, John C Lee, Thomas C King, Carol L Rosenberg. Triple-negative breast cancers are increased in black women regardless of age or body mass index. Breast Cancer Res 2009;11(2):PS10.

Sanz MI, Maqueda AA, Riera MC, Xaurado RF, Casas FT, Gimferrer MC, Perez CA, Hernandez AÚ. Clinical features and prognosis of triple negative breast cancer. BCR 2009;11(suppl 1):26.

Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, Lickley LA, Rawlinson E, Sun P, Narod SA. triple negative breast cancer:clinical features and patterns of reccurence. Clin Cancer Res 2007;13(15)Pt1:4429-34.

Ann J, Kang S, Kwun K. Clinicopathologic characteristics of triple-negative breast cancer in early stages. Eur J Cancer Supp 2008;6(7):183.

Lin N, Claus E, Sohl J, Razzak AR, Arnaout A, Winer P. Sites of distant relapse and clinical outcomes in patients with metastatic triple-negative breast cancer 2:high= incidence of central nervous system metastases. Cancer 2008;113(10):2638-45.

Basu S, Chen W, Tchou J, Mavi A, Cermik T, Czerniecki B, Schnall M, Alavi A. Comparison of triple-negative and estrogen receptor-positive/progestrone receptorpositive/ HER2-negative breast carcinoma using quantative fluorine-18 fluorodeoxyglucose/ positron emission tomography imaging parameters. American Cancer Society (ACS) 2007;112(5):995-1000.

Rakha EA, El-sayed ME, Green AR, Lee AH, Robertson JF, Ellis IO. Prognostic markers in triple-negative breast cancer. Cancer 2007;109(1):25-32

O’kane G .Triple negative breast cancer: comparative study of clinical features and overall survival in an irish population. EJSO 2008;34(10):1163.

How to Cite
Aghili M, Lashkari M, Farrokhpey AH, Izadi S. Triple-Negative Breast Cancer Survival in Iranian Patients. Acta Med Iran. 51(8):560-566.