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Survival According to the Site of Metastasis in Triple-negative Breast Cancer Patients: the Peruvian Experience

Luis Piedra-Delgado, Diego Chambergo-Michilot, Zaida Morante, Carlos Fairen, Fernando Jerves-Coello, Renato Luque-Benavides, Fresia Casas, Eduarda Bustamante, Cesar Razuri-Bustamante, J. Smith Torres-Roman, Hugo Fuentes, Henry Gomez, Alexis Narvaez-Rojas, Gabriel De la Cruz-Ku, Jhajaira Araujo


Evidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis.


Among the phenotypes of breast cancer, triple-negative breast cancer (TNBC) is characterized by the lack of expression of estrogen, progesterone, and human epidermal growth factor 2 (HER2) receptors [1]. TNBC is frequent in African American and Hispanic women [2], and accounts for 15–20% of all breast cancers [3].

Materials and method

This was retrospective cohort study. We included and reviewed medical records from TNBC patients diagnosed and treated at the “Instituto Nacional de Enfermedades Neoplasicas” (Lima, Peru) from 2000 to 2014. The follow-up was until February 2020. The data were collected from December 2017 to March 2020. Inclusion criteria were as follows: age 18 years and older, breast cancer patients with confirmed a triple negative phenotype, stages I-III at diagnosis, and patients with distant relapse. The study included all the patients who met the inclusion and exclusion criteria. Cases lost to follow-up were excluded.


Ot he 534 TNBC patients presenting recurrence, 390 with distant metastasis (73.03%) were included in the study. The mean age was 48.3 years (SD: 11.9), 98 (25.2%) patients were obese and half were premenopausal (51.0%). The majority of patients had stage III TNBC at diagnosis (78.7%), followed by women with stage II (19.0%), and there were 7 cases of bilateral breast cancer (Table 1). The majority of patients (82.2%) underwent surgery, 58.5% received neoadjuvant chemotherapy (NAC), 41.5% received adjuvant chemotherapy (ACT), and 64.4% received radiotherapy.


We evaluated the association between the site of metastasis site and clinical outcomes in patients with TNBC. The results showed that N staging, CNS metastasis to and multiple metastasis were significant prognostic factors for a worse OS, and multiple metastasis was the only predictor of a worse MS in patients with TNBC and distant metastases.


In conclusion, patients with multiple sites of metastasis have a 2.5-fold higher risk of death compared to those with bone metastasis in terms of OS and MS. Moreover, CNS metastasis is also a predictor of a worse OS compared to bone metastasis. There was no difference in DRFS regarding the different solid organs or according to type of metastasis. Further prospective randomized controlled studies are needed in TNBC patients presenting metastasis to assess different therapeutic modalities and molecular biomarkers.


The authors thank the Universidad Cientifica del Sur for their support in the publication of this research/project.

Citation: Piedra-Delgado L, Chambergo-Michilot D, Morante Z, Fairen C, Jerves-Coello F, Luque-Benavides R, et al. (2024) Survival according to the site of metastasis in triple-negative breast cancer patients: The Peruvian experience. PLoS ONE 19(2): e0293833.

Editor: Divijendra Natha Reddy Sirigiri, BMSCE: BMS College of Engineering, INDIA

Received: May 15, 2023; Accepted: October 19, 2023; Published: February 1, 2024

Copyright: © 2024 Piedra-Delgado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.


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