Observational studyBMC cancer2026
Impact of adjuvant endocrine therapy on disease-free survival in early triple-positive breast cancer: a multicenter retrospective cohort study of the Turkish oncology group.
Observational study in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTriple-positive breast cancer (TPBC), characterized by concurrent ER, PR, and HER2 positivity, poses unique therapeutic challenges due to ER-HER2 crosstalk. The optimal adjuvant endocrine therapy in TPBC patients receiving anti-HER2 regimens remains poorly defined.
methodsThis multicenter retrospective cohort study included 1044 early-stage TPBC patients (stage II-III) treated with neoadjuvant chemotherapy and HER2-targeted therapy between 2007 and 2024. Disease-free survival (DFS) was analyzed using Kaplan-Meier estimates and Cox regression models, with separate multivariate analyses for premenopausal (n = 474) and postmenopausal (n = 570) patients.
resultsAt a median follow-up of 52 months, the 5-year DFS was 88.2% and the pCR rate was 44.3%. Residual disease was the strongest prognostic factor in both menopausal groups. In premenopausal patients, low ER expression (< 50%; HR 2.202; p = 0.003) and stage III disease (HR 2.722; p < 0.001) were independent adverse prognostic factors. Endocrine therapy type was associated with DFS on unadjusted analysis (log-rank p = 0.021) but was not significant after multivariable adjustment (adjusted overall p = 0.069). Although tamoxifen plus LHRH agonist showed a numerically higher recurrence risk than tamoxifen alone in exploratory subgroup comparison (HR 2.124; 95% CI 1.093-4.129; p = 0.026), this finding should be interpreted with caution given the non-significant overall association. In postmenopausal patients, stage III disease was the only independent adverse factor among baseline clinicopathological variables (HR 2.225; p = 0.003), and endocrine therapy type was not associated with DFS (log-rank p = 0.751; adjusted overall p = 0.614).
conclusionsIn this large real-world TPBC cohort, residual disease was the dominant prognostic factor regardless of menopausal status. Endocrine therapy type was not independently associated with DFS after multivariable adjustment in either menopausal group. These findings are hypothesis-generating and should not guide endocrine therapy selection; prospective studies are warranted in premenopausal TPBC.
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