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Abstract Background/Aim Current approaches for locally advanced rectal cancer (LARC) typically recommend neoadjuvant chemoradiotherapy (nCRT) with 5-fluorouracil (5FU) or its oral analogs followed by surgery as the standard of care. However, the question of whether intensifying concurrent chemotherapy by adding oxaliplatin to the 5FU-based backbone can yield better outcomes remains unresolved. This study aimed to investigate the benefits of incorporating oxaliplatin into fluoropyrimidine-based chemoradiotherapy (CRT) to increase locoregional control and survival. Methods Among 290 patients with LARC admitted to the Iran Cancer Institute’s radiation oncology department between January 2008 and December 2019, 29 received CAPEOX (capecitabine 625 mg/m²/bid on RT days and weekly oxaliplatin 50 mg/m²), whereas 293 received capecitabine (825 mg/m² twice daily or rarely 5FU in the first 4 days and last week of radiotherapy (RT)). Variables potentially affecting treatment outcomes were used for propensity score matching. Kaplan‒Meier and log-rank tests were employed for overall survival (OS) and disease-free survival (DFS) analyses and were adjusted with propensity score matching. Results Data from 29 patients who received CAPEOX and 216 patients who received capecitabine were analyzed after propensity score matching without replacement. After propensity score matching, in the multivariate analysis, CAPEOX significantly increased the likelihood of achieving a pathologic complete response (pCR) by 4.38 times (CI: 1.90–10.08, p value

Abstract Background and purpose Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran. Materials and methods A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data. Results Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year. Conclusion There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques.

Abstract Background Reduced ovarian reserve is among the crucial long‐term side effects of using chemotherapy agents in breast cancer, yielding early ovarian failure. On the other hand, vitamin D is an essential factor in protecting the follicles and an important predictive factor for successful IVF therapy. Aim The aim of this study is evaluation of vitamin D as a agent that can reduce fertility complications of chemotherapy specially in young women. Methods Breast cancer patients undergoing chemotherapy at two cancer institutes were enrolled in this study. The case group received 1000 IU of calcitriol, and the AMH level was measured at the baseline, after chemotherapy, and six months after chemotherapy. The primary end point was improvement in the AMH level after six months of chemotherapy. the secondary endpoint was to evaluate the predictive factors of AMH level decline during chemotherapy. Results Between 2018 and 2019, 18 and 15 patients were enrolled in the case and control groups, respectively. The mean AMH level (ngr/ml) of the patients in the case and control group were 3.16 and 2.37 ng/mL, respectively (p‐value = .16). These levels were 0.387 and 0.19 after six months (p‐value = .38). The AMH rise immediately after chemotherapy cycles to six months after chemotherapy, in the case and control groups were 0.86 and 0.44 ng/mL, respectively, which was slightly higher in the case group but not statistically significant between two groups (p‐value = .054). Conclusion Despite a minimal rise in the AMH level after six months of chemotherapy, the study could not demonstrate any protective effect of vitamin D on patients' ovarian reserve undergoing chemotherapy for breast cancer. Further larger studies are needed to evaluate the effect of vitamin D supplements on ovarian reserve beside optimal dose and duration.

Background and Objectives: The non-surgical treatment outcome of gastroesophageal junction (GEJ) adenocarcinoma remains to be defined. We aimed to assess the outcomes of definitive chemoradiation (CRT) of GEJ tumors. Methods: In this retrospective cohort, we evaluated 50 patients with non-metastatic adenocarcinoma of GEJ (Siewert's type I and II) treated by chemoradiation without surgery from 2008 to 2017. The reasons for not undergoing surgery were patient refusal, medical unfitness, de novo metastasis in pre-op restaging, and tumor unresectability or progress at the time of operation. The primary outcome was overall survival; secondary outcomes were progression-free survival and local and distal recurrence. Results: The 1-year, 2-year, and 3-year overall survival rates were 53%, 26%, and 12%, respectively. The 1-year, 2-year, and 3-year progression-free survival rates were 44%, 18%, and 10%, respectively. The univariate Cox regression analysis with log-rank test showed that age group and the reason for not undergoing surgery, histologic grade, radiotherapy duration, and distant recurrence had an almost significant association with overall survival. However, after multivariate analysis, the only independent predictor of survival was a distant failure (P=0.031). Conclusion: Although the outcomes of non-surgical treatments are disappointing in GEJ adenocarcinomas, a few patients may experience long-term survival using definitive CRT. This option should be discussed with all patients who are not candidates for surgery.

Background: Minimizing the overall treatment time is an issue of great importance in cancer management. Concomitant boost is a way of decreasing the overall treatment time in breast cancer. The present prospective randomized study aimed to evaluate the feasibility and toxicity and cosmetic outcome of concomitant weekly boost in patients with breast cancer. Method: Patients with breast cancer who underwent breast conservation surgery and were referred to our Radiation Oncology department from 2018 to 2019 were included in this randomized clinical trial. They were randomized to two groups both of which received conventional (50 Gy in 25 fraction, 5 days a week) whole breast irradiation (WBI) with 10 Gy boost dose to lumpectomy cavity. The boost dose in one group (n = 40) was delivered concomitantly on the 6th day of each week. The other group (n = 42) received the boost dose sequentially after completion of conventional WBI. Skin toxicity and cosmetic outcome was compared between the two groups according to CTCAE-4 skin complications and Harvard criteria. Results: We did not observe any significant differences between the sequential and concomitant groups in terms of acute skin reaction within and one month after completion of radiotherapy. After one year of follow-up, no significant differences were seen concerning the cosmetic outcome between the two groups. No local recurrence was observed after 22 months of follow-up. Conclusion: Accelerated radiotherapy with weekly concomitant boost in breast cancer patients was found to be feasible with an acceptable toxicity profile and cosmetic outcome during one year of follow-up.

Background: Adenoid cystic carcinomas is a rare tumor occurring in major salivary glands. Despite definitive treatment, these aggressive cancers often recur and metastasize with no known effective chemotherapy regimen. The present study aimed to evaluate the recurrence and survival rates of head-and-neck adenoid cystic carcinoma and assess the prognostic factors related to the patients' local recurrence and survival. Method: A retrospective study was conducted on 54 patients with adenoid cystic carcinoma. Demographic data, operative factors of patients before, during, and after surgery were reviewed and finally calculated using the Kaplan-Meier method. Results: Among the 54 patients, 61.1% were female, and 38.9% were male with an average age of 46.00 ± 14.52 years. The survival rate at 12, 24, 36, 60, 84, 100 and 120 months post-surgery were 100, 93.3, 84.4, 48.9, 24.4, 20.0 and 13.3%, respectively. Both the marital status (P = 0.002) and the type of surgery (P = 0.045) were significantly related to the overall survival of the patients, and the local recurrence significantly correlated with overall survival (P = 0.027). Conclusion: According to the findings, marital status, type of surgery, metastases, histological staging, and local recurrence rate were related to the overall survival of the patients. Hence, it is of utmost importance to pay attention to these factors in health centers. It is recommended to opt for case-control and prospective studies with more samples for further investigation in the future.

Abstract Background Increase in total health expenditures is one of the main challenges of health systems worldwide, and its inequality is considered as a concern in global arena especially developing countries. This study aims to measure inequality in the distribution of selected indicators of national health accounts across the Iranian provinces. Methods In this study, the data on health financing agents from provincial health accounts from 2008 to 2016 were collected. Gini coefficient (GC) was used to measure inequality. The population and the number of service providers in each province were the bases to measure the GC. The Coefficient of Variation (CV) and the Rate Ratio (RR) were used to determine the dispersion and variation across the provinces. Disparity index was employed to measure the average deviation of the out-of-pocket (OOP) proportion from the desired OOP proportion presented in national development plans (NDPs) of Iran. Results The distribution of resources using both bases were unequal, especially in OOP, with the highest rate over the years studied, ranging from 0.50 to 0.59. The inequality in public resources was lower, with Health Insurance Organization dropping from 0.42 to 0.40 over the years. CV and RR also confirmed the inequality in health resources distribution. In the years 2014 and 2015, the lowest and highest levels were 0.22 and 0.39, respectively. The values of disparity index for OOP had a fluctuating trend ranging from 37.01 to 65.85%. Conclusion Inequality in the distribution of public health expenditures was moderate to high. Moreover, inequality in private health expenditures was higher than public one. Distribution of OOP spent by households at provincial level showed a high inequality. It is suggested that inequality measures to be considered in NDPs to illustrate how resources are distributed at the geographical level. NHA framework can help to provide robust evidence base for policymaking.

BACKGROUND Esophagectomy is the mainstay of treatment for esophageal cancer. Although different surgical approaches have been described, choosing the most appropriate technique is still on debate. We compared the complications of transhiatal esophagectomy (THE) versus left transthoracic esophagectomy (LTE) among a group of Iranian patients with gastroesophageal junction cancer. METHODS This was a retrospective study between 2011 and 2013 on 40 patients with gastroesophageal cancer. 23 patients underwent THE and the others underwent LTE. 30-day postoperative mortality, complications, duration of hospital stay, and number of dissected lymph nodes were studied. RESULTS 37.5% of the patients had squamous cell carcinoma. No mortality was seen. Totally, 10 patients suffered from complications. Cardiac and pulmonary complications occurred in eight and six patients, respectively. No patients suffered from vocal cord injuries and anastomotic leakage. The mean duration of postoperative hospital stay was 11.82 ± 3.8 days, and the mean number of dissected lymph nodes was 8.2 ± 3.9. No significant difference was seen between the two groups (p > 0.05). CONCLUSION Choosing between the approaches for resection of gastroesophageal cancer may not impact the complications and mortality rates. We propose that LTE approach could be used safely in comparison with THE, and that selecting between THE and LTE may be based on the surgeon’s preference and experience.

Objective: The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care. Methods: Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients. Results: Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities' limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs). Conclusions: Barriers may impact the perceived ability of Iranian patients' with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care.

In the present report, we describe our experience with a 44-year-old male with abnormal retroperitoneal primitive neuroectodermal tumours (PNETs) in our hospital, who was operated on with a spindle cell neoplasm diagnosis.

Background: Prioritization and resource allocation are the most important processes in managing and developing each organization. Given the high turnover and cost of hospitals in health system, this study aimed to provide a model for financial resource allocation with the Goal Programming (GP) in Afzalipour teaching medical center in Kerman. Methods: This mixed method and case-study study was conducted in Afzalipour teaching medical center located in Kerman, south-eastern of Iran. Participating key informants and operation research experts, twelve focus group discussions (FGDs) were developed to extract a goal programming model. Then, the hospital accounting data were collected from 2010- 2013 according to the extracted model. The WinQSB software was used for running the model. Results: The findings of this study showed that the share of personnel costs of this hospital was 72% which 28% was devoted to fee-for-service (FFS) and contractual services, current and other costs were 6%, 2%, and 12%, respectively. However, the findings of goal programming model showed that the optimum and satisfactory amount of personnel costs must be 66%, 14% of which were allocated to the FFS cost. The share of contractual services, current and other costs must be 15%, 2%, and 17%, respectively. Conclusion: The results showed that resource allocation in the hospital follow merely the accounting perspective rather than optimum and satisfactory ones. It is suggested in order to achieve the optimum values, the board of trustees should be institutionalized in practice; moreover, the outsourcing services should be addressed more. Therefore, personal costs which include a large part of costs can be reduced.

Background: The main resources of health care are allocated to hospitals. However, resource bottlenecks are a challenge faced by health systems around the world, especially in developing countries such as Iran. Inefficiencies in resource allocation can increase the constraints in double fold. Therefore, the present study was conducted to determine the allocation of financial resources in one of the hospitals of the board of trustees, Afzalipour Medical Center, Kerman, Iran. Methods: Review of documents, two deep interviews and five focus group discussions with eleven experts were used to collect data in the present qualitative study. Participants were members of the board of trustees and representatives of the financial department of the hospital. Data were then analyzed using content analysis method. Results: Based on the present study, four main themes and ten sub-themes were identified, with main themes including decision-making reference, process, criteria and factors influencing decision-making. In this regard, there was no clear process and criteria for allocating resources at this center, and allocation of resources was done based on a reactive approach, response to critical situations, political currents and financial bottlenecks. Contrary to the potential capacity of the structure of board of trustees, in practice, headship and management played a key role in allocating financial resources. Conclusion: The process of allocating financial resources in the investigated hospital follows a less rational approach and coincided with the chaos theory and the garbage can model of decision-making in the governmental bureaucratic structure. The governmental bureaucratic structure and the board of trustees structure (decentralization) in contrast to each other have led to a disorder, where the lack of transparency in determining goals, criteria and document performance have also exacerbated this disorder. In this regard, the oil-related budget has stabilized the inappropriate allocation of resources.

Purpose : Brachytherapy is a cost-effective method for the management of oral cavity cancers in low to middle income countries. We aimed to evaluate the clinical outcomes of high-dose-rate interstitial brachytherapy (HDR-IBT) in patients with oral cavity cancer. Material and methods: From 2009 to 2013, 78 patients (49 combined external beam radiotherapy [EBRT] plus IBT and 29 IBT monotherapy) with oral cavity cancers had been treated in our center. Slightly more than half the patients were male, and the median age was 54 years. The treatment was planned based on the Paris system. The main outcomes were disease-free and overall survival. Results : The median follow-up duration was 36.5 months (range, 1.17-54.23). The actuarial four-year overall and disease-free survival rates were 83% and 65%, respectively. The local and locoregional control was achieved among 89.74% and 87.17% of patients, respectively. None of the factors including tumor size, node status, gender, and radiation modality (IBT alone vs. IBT + EBRT) had a significant statistical correlation to the local control rate. All the patients tolerated the planned treatment in the IBT alone group. Late complications included a case of trismus and three cases of catheter insertion site fibrosis. Conclusions : HDR-IBT as a monotherapy or in combination with EBRT is an appropriate option for the management of oral cavity squamous cell carcinomas, and supports the improvement in treatment outcomes and toxicity profiles in adjuvant settings.

Abstract Objective Glioblastoma multiforme (GBM) is an aggressive primary tumor with frequent recurrences that leaves patients with a short survival time and a low quality of life. The aim of this study was to review the prognostic factors in patients with glioblastoma multiforme. Material and Methods The focus of this retrospective study was a group of 153 patients with supratentorial GBM tumors, who were admitted to a tertiary-care referral academic center from 2005 to 2013. The factors associated with survival and local recurrence were assessed using the hazard ratio (HR) function of Cox proportional hazards regression and neural network analysis. Results Out of the 153 patients, 99 (64.7%) were male. The average age of the patients was 55.69 ± 15.10 years. The median overall survival (OS) and progression-free survival (PFS) rates were 14.0 and 7.10 months respectively. In the multivariate analysis, age (HR = 2.939, p

Background: Accelerated partial breast irradiation (APBI) is defined as applying high doses of radiation with a shorter interval to the lumpectomy cavity in the setting of breast-conserving therapy for early-stage breast cancer. This treatment strategy is attractive to patients, and its utilization has increased during recent years because of the shorter treatment schedule, better cosmetic outcomes, and acceptable local control rates in selected patients undergoing breast-conserving therapy. Here we provide an overview of various APBI techniques in terms of clinical and cosmetic outcomes, quality of life, and cost of treatment. We also review the current guidelines for selecting suitable breast cancer patients for APBI strategy. Methods: A comprehensive literature search of PubMed between 1996 -2019 that was made was made for case series and randomized studies with at least 2 years of follow-up in term of clinical and cosmetic outcomes, quality of life, and treatment costs. Results: Technological advances have made various APBI modalities, including intracavitary and interstitial brachytherapy, intraoperative radiation therapy, and external-beam radiation therapy, more accessible in the community. Mature data from several randomized and prospective nonrandomized trials have contributed to the development of consensus guidelines for selecting the most appropriate candidates ABPI. Conclusion: APBI represent an attractive treatment option for appropriately selected patients with early breast cancer. Irrespective to various techniques used for APBI it is very important to select the most appropriate patient population according to reliable guidelines for this treatment strategy that could be non-inferiority to whole breast irradiation especially in high-volume radiation centers with long waiting lists and for patients who live far away from the radiotherapy centers.

In this study, the observer-based state feedback stabilizer design for a class of chaotic systems in the existence of external perturbations and Lipchitz nonlinearities is presented. This manuscript aims to design a state feedback controller based on a state observer by the linear matrix inequality method. The conditions of linear matrix inequality guarantee the asymptotical stability of the system based on the Lyapunov theorem. The stabilizer and observer parameters are obtained using linear matrix inequalities, which make the state errors converge to the origin. The effects of the nonlinear Lipschitz perturbation and external disturbances on the system stability are then reduced. Moreover, the stabilizer and observer design techniques are investigated for the nonlinear systems with an output nonlinear function. The main advantages of the suggested approach are the convergence of estimation errors to zero, the Lyapunov stability of the closed-loop system and the elimination of the effects of perturbation and nonlinearities. Furthermore, numerical examples are used to illustrate the accuracy and reliability of the proposed approaches.

مقدمه: شرط دستیابی به اهداف نظام سلامت، بهره‌مندی عادلانه افراد جامعه از خدمات سلامت کارا و اثربخش می‌باشد. عادلانه بودن خدمات سلامت و مشارکت عادلانه مردم بستگی زیادی به نظام تامین مالی دارد که در این راستا، نظام اطلاعات مالی برای تصمیم‌گیری در نظام سلامت و تحقق عدالت از جایگاه خاصی برخوردار می‌باشد. با توجه به استقلال استان‌ها و اهمیت موضوع تخصیص عادلانه منابع در جهت ارتقا نظام اطلاعات مالی حوزه سلامت در استان ضرورت می‌یابد. لذا مطالعه حاضر با هدف تعیین چالش‌های پیاده‌سازی این نظام اطلاعاتی یعنی حساب‌های استانی سلامت انجام پذیرفت. روش بررسی: مطالعه حاضر از نوع کیفی بود. جامعه پژوهش شامل کارشناسان سازمان های درگیر اجرای حساب‌های استانی سلامت بود که بیست و هشت نفر از خبرگان و کارشناسان دوازده سازمان استان کرمان نمونه پژوهش را تشکیل داد که به صورت هدفمند براساس معیار مسولیت مرتبط انتخاب گردیدند. برای جمع آوری داده‌ها از روش گروه کاری متمرکز استفاده شد همچنین برای تکمیل داده‌ها از بررسی گزارشات سازمانی استفاده و به منظور تحليل داده‏ها روش تحليل چارچوبي بکارگرفته شد. یافته‌ها: جهت استقرار حساب‌های استانی سلامت در استان کرمان شش چالش اصلی بیست و دو چالش فرعی شناسایی گردید. که به ترتیب چالش‌های تولیت و جایگاه حقوقی، همکاری و ارتباطات، نیروی انسانی، فرایند، فناوری و دانش شناسایی گردید که در این میان مهمترین چالش مشخص نبودن جایگاه تولیت حساب‌های استانی سلامت بود. نتیجه گیری: زیر ساخت‌های مناسب جهت پیاده‌سازی نظام حساب‌ استانی سلامت مبتنی بر چارچوب مدل تغییر مناسب ارزیابی نشد که براساس نتایج حاصل برای رفع چالش‌های موجود و به منظور ارتقای جایگاه تولیت حساب‌های استانی سلامت جهت استقرار این نظام اطلاعاتی تشکیل کمیسیون تخصصی مالی و اقتصادی حوزه سلامت زیر مجموعه شورای سلامت استان‌ها پیشنهاد گردید.

Sarcomas are rare tumors account for about 1% of cancers in adult. Soft tissue sarcomas are the most common one. Synovial sarcoma's incident is about 10% of all sarcomas and most commonly rise from para-articular regions in young adults. Based on our knowledge there have been only two reports of thyroid synovial sarcoma in medical literature. We report a 44-year old woman presented with a rapid growing neck mass. The pathology report revealed sarcoma and the immunohistochemistry (IHC) was compatible with synovial sarcoma. It could be understood that synovial sarcoma can be found in various tissues even if there is no synovial cells.

Background: Postoperative breast abnormalities after breast conserving surgery or modified radical mastectomy are frequently overlooked and inaccurately assessed or reported using multidetector computed tomography (MDCT). These inaccurate results may have legal ramifications for the clinicians, cause patients avoidable anxiety, and lead to additional unnecessary diagnostic follow-up testing and costs. Methods: The patients with a history of breast cancer who had undergone breast-conserving surgery or modified radical mastectomy up to 6 months prior to undergoing a thoracic MDCT scan consented and enrolled in this study. These patients underwent a thoracic MDCT scan either because of respiratory or cardiac clinical symptoms or as part of breast cancer staging. Results: Forty women were included in this study. Different postoperative breast changes observed on thoracic MDCT scans including fibrous scar tissue, fat necrosis, seroma, abscess, hematoma, and recurrent and residual tumor were described. Conclusions: MDCT scans offer sufficient evidence in many postoperative cases to allow a confident diagnosis. General radiologists who review thoracic MDCT scans should know how to characterize breast lesions incidentally found on MDCT scans after breast surgeries. This information would enhance the value of the radiologist’s report for appropriate case management.

We argue that the field of medicine ought to think over the definition of medical professionalism and the challenges that doctors face in everyday practice. Although there are a diversity of definitions revolving around medical professionalism, but the most recent and revalidated definition should be taken into account. In addition, we highlight four barriers threatening professionalism: 1) doctors’ of self-interest; 2) doctors’ temptation to deviate from the standards of medicine; 3) market incentives (financial conflicts of interest); and 4) peer pressures. We conclude with suggestions for remedies to overcome these threats, e.g. selection criteria of medical students, and stringent rules and guidelines.

This study focused on triple-negative breast cancer (TNBC) that is characterized by the lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). The primary goal of this study was to describe the relation between triple-negative receptor status and survival. This is the first study about triple-negative breast cancer in our community of the 1541 patients diagnosed with breast cancer between 2002 and 2007 at the Cancer Institute (Tehran, Iran). 107 patients were identified as TNBC and 107 patients were randomly selected as non-TNB. HER-2, ER and PR status were assessed by immunohistochemistry (IHC). Analyses of their collected data were performed retrospectively and then clinical and pathologic parameters were compared between two groups. In multivariate analysis, a significantly decreased overall survival was observed for patients with TNBC compared with non-TNBC (55.7 months versus 60.7 mounts; 95%CI: 51.1-60.3 and 57.9-63.5 for TNBC and non-TNBC respectively, P=0.0008). The 2- and 5-year estimates for overall survival were 69.8% and 62.3% for TNBC, and 90% and 83% for non-TNBC, respectively. During the study period, 36 (33.6%) patient of TNBC and 14 (13.1%) of non-TNBC presented local recurrence. Significantly decreased disease-free survival was also observed for patients with TNBC compared with non-TNBC (P=0.0004). The 2- and 5-year estimates for disease-free survival were 68% and 63% for TNBC; and 89% and 82% for non-TNBC, respectively. Significantly decreased distant metastasis free survival was also observed for patients with TNBC compared with non-TNBC (54.4 mounts versus 61.7 mounts; 95%CI: 49.8-59.0 and 59.1-64.4 for TNBC and non-TNBC respectively, P=0.0004). Triple negative breast cancer has a biologic aggressive behavior and poor prognosis. Therefore aggressive treatment and regular follow-up in early stage of diagnosis can be a significant impact on their prognosis.