![]() ![]() Mitotic activity is an established prognostic feature reflecting tumor biology also in breast cancer, especially in the luminal subtype. Uncontrollable proliferation is one of the crucial properties of malignant transformation. In most cases, the course of disease of a single TNBC patient is still unpredictable and, therefore, there is a constant need for intensified, clinically applicable, personalized prognostic markers. stage, patient’s age at diagnosis and, to some extent, the proliferative activity of the malignant cells. In clinical practice, international guidelines for treatment decisions of TNBC are based on the traditional prognostic features of breast cancer, i.e. Still, in the majority of TNBC cases, no clinically applicable expression signatures are available for identifying the prognosis of individual patients. immune checkpoint, AKT pathway and PARP inhibitors, have provided promising treatment options for subgroups of TNBC patients with high mutational burden and germline BRCA mutations. TNBC comprises several tumor subtypes with varying biological characteristic and behavioral patterns. Consequently, the average 5 year survival rate is reported to be considerably lower among TNBC patients (77%) than among breast cancer patients in general (91%) (American Cancer Society 2022). Among these, triple-negative breast cancer (TNBC) remains a major challenge since it affects younger patients than the other subtypes and inflicts a particularly aggressive course of disease. Increased proliferation, as evaluated using Ki-67 or geminin immunohistochemistry, showed potential in detecting survival differences in subgroups of TNBC.īreast cancer presents as distinctive subtypes with various behavioral patterns. Young age should be considered as an additional adverse prognostic feature in therapeutic considerations. Traditional clinical features do not provide optimal prognostic characterization for all TNBC patients. Among the studied cell cycle-specific biomarkers, only geminin predicted disease outcome, indicating up to 6.2-fold increased risk of mortality for tumor size < 2 cm ( p = 0.03). Concerning cell proliferation, Ki-67 alone was a significant prognosticator among patients aged > 57 years ( p = 0.009). Among patients aged > 57, the established prognostic features predicted disease outcome with up to 3.0-fold mortality risk for tumor size ≥ 2 cm ( p = 0.001). Among young patients, only lack of basal differentiation predicted disease outcome, indicating 4.5-fold mortality risk ( p = 0.03). The outcome and prognostic features differed significantly between age groups, middle-aged patients showing the most favorable outcome. The established prognostic features, nodal status and Ki-67, predicted survival only when combined with age. ResultsĪge at diagnosis was the decisive factor predicting disease-specific mortality in TNBC ( p = 0.002). Eight biomarkers for cell division were immunohistochemically detected to evaluate their clinical applicability in relation to patient and tumor characteristics. One hundred forty seven TNBC patients with complete clinical data and up to 18 year follow-up were collected from Turku University Hospital, Finland. We evaluated the combined prognostic impact of clinical features and novel biomarkers of cell cycle-progression in age-dependent subgroups of TNBC patients. Triple-negative breast cancer (TNBC) is an aggressive disease lacking specific biomarkers to guide treatment decisions.
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