High Ki‐67 proliferation index and lack of chemotherapy are associated with reduced overall survival in patients with triple negative breast cancer: A retrospective cohort in a major breast centre in Hong Kong

• Published in: Surgical practice 2021-11, Vol.25 (4), p.193-198
• Main Authors: Hung, Ray Ka‐wai, Chiu, Tiffany Hoi‐wun, Tsoi, Yee‐kei, Chan, Wing‐cheong
• Format: Article
• Language: English
• Subjects: Breast cancer; Chemotherapy; Lymphatic system; Medical prognosis; Metastasis
• ISSN: 1744-1625; 1744-1633
• DOI: 10.1111/1744-1633.12527

Background Triple negative breast cancer (TNBC) is the most aggressive molecular subtype of breast cancer. The management of TNBC is challenging due to the lack of effective treatment. In this study, all patients diagnosed to have TNBC, managed in the Department of Surgery, North District Hospital, were identified and possible prognostic markers including age, menopausal status, Ki‐67 proliferation index, TNM stage and the treatment received by the patients were assessed for possible association on the overall survival rate. Methods The pathology results of patients diagnosed to have breast cancer from 2012 to 2017 were reviewed. Relevant information was retrieved by reviewing the clinical notes in the clinical management system retrospectively. Result A total of 169 patients with TNBC were identified. The 5‐year overall survival rate in this group of patients is 68%. In univariate analysis, age, high Ki‐67 proliferation index, T3 and T4 disease, lymph node involvement, distant metastasis, the lack of chemotherapy and the lack of radiotherapy are significant prognostic indicators. When analysing them in multivariate analysis, T4 disease (HR, 4.663; 95% CI, 1.209–17.988), lymph node involvement (2.361; 95% CI, 1.002–5.561), distant metastasis (2.262; 95% CI, 1.012–5.057), high Ki‐67 proliferation index (HR, 2.329; 95% CI, 1.026–5.278) and lack of chemotherapy (HR, 3.725; 95% CI, 1.247–11.123) remain statistically significant. Conclusion Beside advance disease status, high Ki‐67 proliferation index and lack of systemic chemotherapy are another two important prognostic factors in patients with triple negative breast cancer. Chemotherapy is strongly advised in patients with TNBC whenever they are medically fit.