Impact of Age on Outcomes in Women with Triple-Negative Breast Cancer Treated with Neoadjuvant Chemotherapy

Previous literature suggests that age does not impact outcomes in women with triple-negative breast cancer (TNBC). Young women have a higher rate of achieving pathologic complete response (pCR); however, the impact of age on outcomes and the type of surgery performed following neoadjuvant chemotherapy (NAC) is not well studied.

An institutional retrospective database review identified women with TNBC who underwent NAC followed by surgery from 03/2010 to 09/2019. Clinicopathologic, treatment, and outcome variables were compared between women aged <40 and ≥40 years at diagnosis. The association between type of surgery and outcomes was examined.

Among 515 women, 104 (20%) were aged <40 years and 411 (80%) were ≥40. Compared to women ≥40, younger women presented at a similar clinical stage; were more likely to have a high-penetrance gene mutation, a higher overall pCR rate, and undergo a mastectomy; and less likely to receive adjuvant radiotherapy (all p < 0.01). Median follow-up was 2.8 years (interquartile range 1.6-4.7). 5-year locoregional recurrence (LRR) and distant recurrence (DR) rates did not significantly differ between these 2 age groups (LRR/7.9% vs. 8.7%, p = 0.6; DR/15.2% vs. 18.4%, p = 0.6). On multivariable analysis, lymphovascular invasion and nodal positivity were significantly associated with a decrease in overall and breast-cancer-specific survival. Age <40 years was not associated with survival. Women who opted for bilateral mastectomy were more likely to achieve a pCR.

Young age was not an independent predictor of recurrence and survival outcomes in women with TNBC treated with NAC. Further studies with ongoing advancement in NAC are crucial.