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Triple-negative Breast Carcinoma in African American and Caucasian Women: Clinicopathology, Immunomarkers, and Outcome

Sullivan, Harold C. MD*; Oprea-Ilies, Gabriela MD*; Adams, Amy L. MD*; Page, Andrew J. MD; Kim, Sungjin MS; Wang, Jason MD*; Cohen, Cynthia MD*

Applied Immunohistochemistry & Molecular Morphology: January 2014 - Volume 22 - Issue 1 - p 17–23
doi: 10.1097/PAI.0b013e318281148e
Research Articles

Purpose: Breast cancers are often classified on the presence/absence of hormone receptors, and growth factor oncogenes (estrogen receptor, progesterone receptor, HER2). Triple-negative breast cancers, negative for these markers, do not benefit from targeted therapy. We compared clinicopathologic parameters and immunohistochemical markers of prognostic and/or predictive significance, and outcome between African American and Caucasian triple-negative breast cancer patients.

Methods: Invasive triple-negative breast cancers from African American (n=94) and Caucasian (n=68) patients were studied. Clinicopathologic features (age, tumor size, grade, lymph node status, angiolymphatic invasion, visceral metastases) and survival (overall and progression free) were compared. Marker expression (CK5, CK7, CK8, CK14, CK18, CK19, vimentin, CD44, c-Kit, epidermal growth factor receptor, p-cadherin, p53, p63, topoisomerase II, androgen receptor, Ki-67) was assessed in tissue microarrays.

Results: Significant differences between African American and Caucasian women were observed for mean age and tumor size. African Americans had a trend toward greater lymph node involvement than Caucasians. The following markers were found in significantly different frequencies between the 2 groups: CK5, CK8, CK19, c-Kit, androgen receptor, and high Ki-67. African Americans show shorter overall and progression-free survival. Other clinicopathologic parameters, markers, and outcome were present at similar frequencies.

Discussion: African American triple-negative breast cancers were more aggressive, occurring at a younger age, being larger, with higher proliferation, patients more frequently dying of disease, and with a trend toward positive lymph node status. Heterogeneity of marker expression suggests variation in the genetics of breast carcinomas in different races.

Departments of *Pathology and Laboratory Medicine

Surgery, Emory University School of Medicine

Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA

The authors declare no conflict of interest.

Reprints: Harold C. Sullivan, MD, Emory University Hospital, 1364 Clifton Road NE, Room H183, Atlanta, GA 30322 (e-mail:

Received October 9, 2012

Accepted December 3, 2012

© 2014 Lippincott Williams & Wilkins, Inc.