Five-year survival of triple-negative breast cancer and the associated clinicopathological factors: a study in an Indonesian tertiary hospital

  • Erwin Danil Yulian Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ihza Fachriza Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: breast cancer, Indonesia, prognosis, survival, triple-negative breast cancer
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BACKGROUND Triple-negative breast cancer (TNBC) has a worse rate of recurrence, survival, and overall survival. This study aimed to find the survival of TNBC and its clinicopathological factors at Cipto Mangunkusumo Hospital.

METHODS This study used survival analysis based on clinicopathology in 112 TNBC cases at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, diagnosed from 2009 to 2019. Kaplan–Meier and log-rank tests were used for the analysis. Bivariate and multivariate analyses using Cox regression were performed to obtain the hazard ratios (HRs).

RESULTS Most patients were diagnosed at the locally advanced stage (40.2%) compared to the early (33.0%) and metastatic stages (17.9%). The 5-year survival of TNBC was 81.2% with an HR value of 1.372 (p = 0.239) compared to luminal A. Bivariate analyses showed that the older age group with an HR of 6.845 (p = 0.013; CI 1.500–31.243), larger tumor size and extension (T) with an HR of 11.826 (p = 0.001; CI 2.707–51.653), broader regional lymph node involvement (N) with an HR of 8.929 (p = 0.019; CI 1.434–55.587), farther distant metastases (M) with an HR of 3.016 (p = 0.015; CI 1.242–7.322), more lymphovascular invasion with HR of 3.006 (p = 0.018; CI 1.209–7.477), and not operated-on cases with an HR of 9.165 (p<0.001; CI 3.303–25.434) significantly shortened the survival of TNBC. Multivariate analysis found that the only factor worsening the survival was not having surgery, with an HR of 6.175 (p<0.001; CI 1.518–34.288).

CONCLUSIONS The 5-year survival rate of TNBC patients was 81.2%. Not having surgery was a clinicopathological factor that worsened survival outcomes in TNBC.


  1. World Health Organization. Fact sheets by cancer breast cancer estimated incidence, mortality and prevalence worldwide in 2012 [Internet]. World Health Organization; 2012 [cited 2018 Jan 14]. p. 1-4. Available from:

  2. Gondhowiardjo S. Cancer epidemiology based on Hospital-Based Cancer Registry at National Referral Hospital of Indonesia, 2013. eJKI. 2021;9(1):36-43.

  3. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, editors. AJCC cancer staging manual eight edition. Definitions. Spinger; 2020.

  4. Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747-52.

  5. Boyle P. Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol. 2012;23 Suppl 6:vi7-12.

  6. Knaj D, Georgeos M. Pathological and clinical characteristics of triple negative breast cancer and disease relapse. Int J Clin Oncol Cancer Res. 2020;5(4):78-81.

  7. Qiu J, Xue X, Hu C, Xu H, Kou D, Li R, et al. Comparison of clinicopathological features and prognosis in triple-negative and non-triple negative breast cancer. J Cancer. 2016;7(2):167-73.

  8. Abubakar M, Sung H, Bcr D, Guida J, Tang TS, Pfeiffer RM, et al. Breast cancer risk factors, survival and recurrence, and tumor molecular subtype: analysis of 3012 women from an indigenous Asian population. Breast Cancer Res. 2018;20(1):114.

  9. Jitariu AA, Cîmpean AM, Ribatti D, Raica M. Triple negative breast cancer: the kiss of death. Oncotarget. 2017;8(28):46652-62.

  10. Urru SAM, Gallus S, Bosetti C, Moi T, Medda R, Sollai E, et al. Clinical and pathological factors influencing survival in a large cohort of triple-negative breast cancer patients. BMC Cancer. 2018;18(1):56.

  11. Park YH, Lee SJ, Cho EY, Choi Y, Lee JE, Nam SJ, et al. Clinical relevance of TNM staging system according to breast cancer subtypes. Ann Oncol. 2011;22(7):1554-60. Erratum in: Ann Oncol. 2019;30(12):2011.

  12. Mousavi SA, Kasaeian A, Pourkasmaee M, Ghavamzadeh A, Alimoghaddam K, Vaezi M, et al. Assessing the prognostic factors, survival, and recurrence incidence of triple negative breast cancer patients, a single center study in Iran. PLoS One. 2019;14(1):e0208701.

  13. Howlader N, Cronin KA, Kurian AW, Andridge R. Differences in breast cancer survival by molecular subtypes in the United States. Cancer Epidemiol Biomarkers Prev. 2018;27(6):619-26.

  14. Erić I, Petek Erić A, Kristek J, Koprivčić I, Babić M. Breast cancer in young women: pathologic and immunohistochemical features. Acta Clin Croat. 2018;57(3):497-502.

  15. Lee HB, Han W. Unique features of young age breast cancer and its management. J Breast Cancer. 2014;17(4):301-7.

  16. Gajdos C, Tartter PI, Bleiweiss IJ, Bodian C, Brower ST. Stage 0 to stage III breast cancer in young women. J Am Coll Surg. 2000;190(5):523-9.

  17. Wang XX, Jiang YZ, Li JJ, Song CG, Shao ZM. Effect of nodal status on clinical outcomes of triple-negative breast cancer: a population-based study using the SEER 18 database. Oncotarget. 2016;7(29):46636-45.

  18. Vinh-Hung V, Verkooijen HM, Fioretta G, Neyroud-Caspar I, Rapiti E, Vlastos G, et al. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol. 2009;27(7):1062-8.

  19. He M, Zhang JX, Jiang YZ, Chen YL, Yang HY, Tang LC, et al. The lymph node ratio as an independent prognostic factor for node-positive triple-negative breast cancer. Oncotarget. 2017;8(27):44870-80.

  20. Tsai J, Bertoni D, Hernandez-Boussard T, Telli ML, Wapnir IL. Lymph node ratio analysis after neoadjuvant chemotherapy is prognostic in hormone receptor-positive and triple-negative breast cancer. Ann Surg Oncol. 2016;23(10):3310-6.

  21. Cho DH, Bae SY, You JY, Kim HK, Chang YW, Choi YJ, et al. Lymph node ratio as an alternative to pN staging for predicting prognosis after neoadjuvant chemotherapy in breast cancer. Kaohsiung J Med Sci. 2018;34(6):341-7.

  22. Grinda T, Antoine A, Jacot W, Cottu PH, de la Motte Rouge T, Frenel JS, et al. Real-world clinical and survival outcomes of patients with early relapsed triple-negative breast cancer from the ESME national cohort. Eur J Cancer. 2023;189:112935.

  23. Chintalapani SR, Bala S, Konatam ML, Gundeti S, Kuruva SP, Hui M. Triple-negative breast cancer: pattern of recurrence and survival outcomes. Indian J Med Paediatr Oncol. 2019;40(01):67-72.

  24. Jin J, Gao Y, Zhang J, Wang L, Wang B, Cao J, et al. Incidence, pattern and prognosis of brain metastases in patients with metastatic triple negative breast cancer. BMC Cancer. 2018;18(1):446.

  25. Fanizzi A, Pomarico D, Paradiso A, Bove S, Diotaiuti S, Didonna V, et al. Predicting of sentinel lymph node status in breast cancer patients with clinically negative nodes: a validation study. Cancers (Basel). 2021;13(2):352.

  26. Houvenaeghel G, Cohen M, Classe JM, Reyal F, Mazouni C, Chopin N, et al. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open. 2021;6(6):100316.

  27. Gujam FJ, Going JJ, Mohammed ZM, Orange C, Edwards J, McMillan DC. Immunohistochemical detection improves the prognostic value of lymphatic and blood vessel invasion in primary ductal breast cancer. BMC Cancer. 2014;14:676.

  28. Abdulkarim BS, Cuartero J, Hanson J, Deschênes J, Lesniak D, Sabri S. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. J Clin Oncol. 2011;29(21):2852-8.

  29. Lin YY, Gao HF, Yang X, Zhu T, Zheng XX, Ji F, et al. Neoadjuvant therapy in triple-negative breast cancer: a systematic review and network meta-analysis. Breast. 2022;66:126-35.

  30. Yin L, Duan JJ, Bian XW, Yu SC. Triple-negative breast cancer molecular subtyping and treatment progress. Breast Cancer Res. 2020;22(1):61.

  31. Li X, Yang J, Peng L, Sahin AA, Huo L, Ward KC, et al. Triple-negative breast cancer has worse overall survival and cause-specific survival than non-triple-negative breast cancer. Breast Cancer Res Treat. 2017;161(2):279-87.

  32. Sopik V, Narod SA. The relationship between tumour size, nodal status and distant metastases: on the origins of breast cancer. Breast Cancer Res Treat. 2018;170(3):647-56.

  33. Kasangian AA, Gherardi G, Biagioli E, Torri V, Moretti A, Bernardin E, et al. The prognostic role of tumor size in early breast cancer in the era of molecular biology. PLoS One. 2017;12(12):e0189127.

  34. Kristman V, Manno M, Côté P. Loss to follow-up in cohort studies: how much is too much? Eur J Epidemiol. 2004;19(8):751-60.

How to Cite
Yulian ED, Fachriza I. Five-year survival of triple-negative breast cancer and the associated clinicopathological factors: a study in an Indonesian tertiary hospital. Med J Indones [Internet]. 2024Feb.23 [cited 2024May31];32(4):230-7. Available from:
Clinical Research