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

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.