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三陰性乳癌：修订间差异

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多采用联合治疗的说法不准确，这个要看具体分型和临床试验进展的，目前许多药物还在试验，而且即便试验成功了，不知道临床实践的跟进速度如何，不能随便下结论的。英文维基有时候非常美国中心，例如把美国病例比例当作全世界的比例，把美国的诊断方法当作全世界的诊断方法，需要注意。
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三阴性作为一种侵袭性[[表现型|表型]]，主要表现为基底样或正常乳腺样肿瘤<ref name=":2" />，90%为单灶性浸润性导管癌<ref name=":2" />。该型癌症易发[[遠端轉移|转移]]，复发较多且较早，缺乏{{Tsl|en|Approved drug|获批准药物|获批准}}的[[靶向治疗]]方法<ref name=":3" />。该型癌症具有高度[[同質與異質|异质性]]，因此可能并非单一疾病，而是不同疾病之集合<ref name=":0">{{Cite journal|title=Triple-Negative Breast Cancer|author=|url=https://www.nejm.org/doi/full/10.1056/NEJMra1001389|first1=William D.|last2=Smith|first2=Ian E.|journal=New England Journal of Medicine|issue=20|doi=10.1056/Nejmra1001389|others=|year=2010|volume=363|page=|pages=1938–1948|pmid=|last3=Reis-Filho|first3=Jorge S.|last1=Foulkes}}</ref>，依据组织学、细胞起源、突变、转移潜能、疾病进展、治疗反应和临床结果等，还可以分出可以采取不同治疗策略的亚型<ref name=":1" /><ref name=":4">{{Cite journal|title=Triple negative breast cancer in Asia: An insider’s view|author=|url=https://linkinghub.elsevier.com/retrieve/pii/S0305737217301846|last=Wang|first=Chao|last2=Kar|first2=Shreya|date=2018-01|journal=Cancer Treatment Reviews|issue=|doi=10.1016/j.ctrv.2017.10.014|others=|year=|volume=62|page=|pages=29–38|language=en|pmid=|last3=Lai|first3=Xianning|last4=Cai|first4=Wanpei|last5=Arfuso|first5=Frank|last6=Sethi|first6=Gautam|last7=Lobie|first7=Peter E.|last8=Goh|first8=Boon C.|last9=Lim|first9=Lina H.K.}}</ref>，如针对BCRA突变的患者已经出现{{Tsl|en|PARP inhibitor|PARP抑制剂}}等[[靶向治疗]]药物<ref>{{Cite journal|title=Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation|url=https://doi.org/10.1056/NEJMoa1706450|last=Robson|first=Mark|last2=Im|first2=Seock-Ah|date=2017-08-10|journal=New England Journal of Medicine|issue=6|doi=10.1056/NEJMoa1706450|volume=377|pages=523–533|issn=0028-4793|pmid=28578601|last3=Senkus|first3=Elżbieta|last4=Xu|first4=Binghe|last5=Domchek|first5=Susan M.|last6=Masuda|first6=Norikazu|last7=Delaloge|first7=Suzette|last8=Li|first8=Wei|last9=Tung|first9=Nadine}}</ref><ref>{{Cite web|url=https://med.sina.com/article_detail_103_2_43195.html|title=PARP抑制剂在三阴性乳腺癌中的应用|accessdate=2019-05-14|author=佩妮|date=2018-03-23|publisher=药渡|via=新浪医药}}</ref><ref>{{Cite journal|title=A phase 3 trial comparing talazoparib, an oral PARP inhibitor, to physician’s choice of therapy in patients with advanced breast cancer and a germline BRCA mutation: EMBRACA subgroups by age|author=|url=https://www.thebreastonline.com/article/S0960-9776(18)30177-2/abstract|last=Litton|first=Jennifer|last2=Hannah|first2=Alison|date=2018-10-01|journal=The Breast|issue=|doi=10.1016/j.breast.2018.08.034|others=|year=|volume=41|page=|pages=S12|language=en|issn=0960-9776|pmid=|last3=Blum|first3=Joanne|last4=Tudor|first4=Iulia|last5=Markova|first5=Denka|last6=Miguel|first6=Martin|last7=Gonçalves|first7=Anthony|last8=Hurvitz|first8=Sara A.|last9=Ettl|first9=Johannes}}</ref>。不同亚型对药物的反应也不同，如病人无BRCA1/2突变或有肿瘤浸润淋巴细胞浓度增加，则已有试验证实[[卡铂]]联合[[紫杉醇]]进行{{Tsl|en|Neoadjuvant therapy|新辅助疗法|新辅助}}[[化学疗法|化疗]]效果更好<ref>{{Cite web|url=https://www.cn-healthcare.com/article/20180305/content-500985.html|title=三阴性乳腺癌新辅助化疗标准 柳叶刀揭示卡铂能带来什么？|accessdate=2019-05-15|author=钱多乐|date=2018-03-05|work=医脉通肿瘤科|publisher=|via=健康界}}</ref><ref>{{Cite journal|title=Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial|author=|url=https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30111-6/abstract|last=Geyer|first=Charles E.|last2=Liu|first2=Xuan|date=2018-04-01|journal=The Lancet Oncology|issue=4|doi=10.1016/S1470-2045(18)30111-6|others=|year=|volume=19|page=|pages=497–509|language=en|issn=1470-2045|pmid=29501363|last3=Symmans|first3=W. Fraser|last4=Rastogi|first4=Priya|last5=Filho|first5=Otto Metzger|last6=Lorenzo|first6=Jose J. Ponce|last7=McIntyre|first7=Kristi|last8=Wolmark|first8=Norman|last9=Sullivan|first9=Danielle}}</ref>。对于不同亚型的预后也会有所差异，[[诺丁汉预后指数]]可以帮助进行预后判断，但需要更激进治疗者除外<ref name="Albergaria_2011">{{Cite journal|title=Nottingham Prognostic Index in Triple-Negative Breast Cancer: A reliable prognostic tool?|first1=A.|last2=Ricardo|first2=S.|journal=BMC Cancer|doi=10.1186/1471-2407-11-299|year=2011|volume=11|pages=299|pmc=3151231|pmid=21762477|last3=Milanezi|first3=F.|last4=Carneiro|first4=V. T.|last5=Amendoeira|first5=I.|last6=Vieira|first6=D.|last7=Cameselle-Teijeiro|first7=J.|last8=Schmitt|first8=F.|last1=Albergaria}}</ref>。
三阴性作为一种侵袭性[[表现型|表型]]，主要表现为基底样或正常乳腺样肿瘤<ref name=":2" />，90%为单灶性浸润性导管癌<ref name=":2" />。该型癌症易发[[遠端轉移|转移]]，复发较多且较早，缺乏{{Tsl|en|Approved drug|获批准药物|获批准}}的[[靶向治疗]]方法<ref name=":3" />。该型癌症具有高度[[同質與異質|异质性]]，因此可能并非单一疾病，而是不同疾病之集合<ref name=":0">{{Cite journal|title=Triple-Negative Breast Cancer|author=|url=https://www.nejm.org/doi/full/10.1056/NEJMra1001389|first1=William D.|last2=Smith|first2=Ian E.|journal=New England Journal of Medicine|issue=20|doi=10.1056/Nejmra1001389|others=|year=2010|volume=363|page=|pages=1938–1948|pmid=|last3=Reis-Filho|first3=Jorge S.|last1=Foulkes}}</ref>，依据组织学、细胞起源、突变、转移潜能、疾病进展、治疗反应和临床结果等，还可以分出可以采取不同治疗策略的亚型<ref name=":1" /><ref name=":4">{{Cite journal|title=Triple negative breast cancer in Asia: An insider’s view|author=|url=https://linkinghub.elsevier.com/retrieve/pii/S0305737217301846|last=Wang|first=Chao|last2=Kar|first2=Shreya|date=2018-01|journal=Cancer Treatment Reviews|issue=|doi=10.1016/j.ctrv.2017.10.014|others=|year=|volume=62|page=|pages=29–38|language=en|pmid=|last3=Lai|first3=Xianning|last4=Cai|first4=Wanpei|last5=Arfuso|first5=Frank|last6=Sethi|first6=Gautam|last7=Lobie|first7=Peter E.|last8=Goh|first8=Boon C.|last9=Lim|first9=Lina H.K.}}</ref>，如针对BCRA突变的患者已经出现{{Tsl|en|PARP inhibitor|PARP抑制剂}}等[[靶向治疗]]药物<ref>{{Cite journal|title=Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation|url=https://doi.org/10.1056/NEJMoa1706450|last=Robson|first=Mark|last2=Im|first2=Seock-Ah|date=2017-08-10|journal=New England Journal of Medicine|issue=6|doi=10.1056/NEJMoa1706450|volume=377|pages=523–533|issn=0028-4793|pmid=28578601|last3=Senkus|first3=Elżbieta|last4=Xu|first4=Binghe|last5=Domchek|first5=Susan M.|last6=Masuda|first6=Norikazu|last7=Delaloge|first7=Suzette|last8=Li|first8=Wei|last9=Tung|first9=Nadine}}</ref><ref>{{Cite web|url=https://med.sina.com/article_detail_103_2_43195.html|title=PARP抑制剂在三阴性乳腺癌中的应用|accessdate=2019-05-14|author=佩妮|date=2018-03-23|publisher=药渡|via=新浪医药}}</ref><ref>{{Cite journal|title=A phase 3 trial comparing talazoparib, an oral PARP inhibitor, to physician’s choice of therapy in patients with advanced breast cancer and a germline BRCA mutation: EMBRACA subgroups by age|author=|url=https://www.thebreastonline.com/article/S0960-9776(18)30177-2/abstract|last=Litton|first=Jennifer|last2=Hannah|first2=Alison|date=2018-10-01|journal=The Breast|issue=|doi=10.1016/j.breast.2018.08.034|others=|year=|volume=41|page=|pages=S12|language=en|issn=0960-9776|pmid=|last3=Blum|first3=Joanne|last4=Tudor|first4=Iulia|last5=Markova|first5=Denka|last6=Miguel|first6=Martin|last7=Gonçalves|first7=Anthony|last8=Hurvitz|first8=Sara A.|last9=Ettl|first9=Johannes}}</ref>。不同亚型对药物的反应也不同，如病人无BRCA1/2突变或有肿瘤浸润淋巴细胞浓度增加，则已有试验证实[[卡铂]]联合[[紫杉醇]]进行{{Tsl|en|Neoadjuvant therapy|新辅助疗法|新辅助}}[[化学疗法|化疗]]效果更好<ref>{{Cite web|url=https://www.cn-healthcare.com/article/20180305/content-500985.html|title=三阴性乳腺癌新辅助化疗标准 柳叶刀揭示卡铂能带来什么？|accessdate=2019-05-15|author=钱多乐|date=2018-03-05|work=医脉通肿瘤科|publisher=|via=健康界}}</ref><ref>{{Cite journal|title=Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial|author=|url=https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30111-6/abstract|last=Geyer|first=Charles E.|last2=Liu|first2=Xuan|date=2018-04-01|journal=The Lancet Oncology|issue=4|doi=10.1016/S1470-2045(18)30111-6|others=|year=|volume=19|page=|pages=497–509|language=en|issn=1470-2045|pmid=29501363|last3=Symmans|first3=W. Fraser|last4=Rastogi|first4=Priya|last5=Filho|first5=Otto Metzger|last6=Lorenzo|first6=Jose J. Ponce|last7=McIntyre|first7=Kristi|last8=Wolmark|first8=Norman|last9=Sullivan|first9=Danielle}}</ref>。对于不同亚型的预后也会有所差异，[[诺丁汉预后指数]]可以帮助进行预后判断，但需要更激进治疗者除外<ref name="Albergaria_2011">{{Cite journal|title=Nottingham Prognostic Index in Triple-Negative Breast Cancer: A reliable prognostic tool?|first1=A.|last2=Ricardo|first2=S.|journal=BMC Cancer|doi=10.1186/1471-2407-11-299|year=2011|volume=11|pages=299|pmc=3151231|pmid=21762477|last3=Milanezi|first3=F.|last4=Carneiro|first4=V. T.|last5=Amendoeira|first5=I.|last6=Vieira|first6=D.|last7=Cameselle-Teijeiro|first7=J.|last8=Schmitt|first8=F.|last1=Albergaria}}</ref>。


该型癌症多发于年轻女性，可能与{{Tsl|en|BRCA1}}[[突变|基因突变]]相关；特定族裔（[[黑人|非洲裔]]、[[西班牙裔]]）等群体呈现高发，可能与较差[[社会经济地位]]相关<ref>{{Cite journal|title=Triple-Negative Breast Cancer: An Unmet Medical Need|url=http://theoncologist.alphamedpress.org/content/16/suppl_1/1|last=Gianni|first=Luca|last2=Hudis|first2=Clifford A.|date=2011-01-01|journal=The Oncologist|issue=Supplement 1|doi=10.1634/theoncologist.2011-S1-01|volume=16|pages=1–11|language=en|issn=1083-7159|pmid=21278435}}</ref>。该型癌症在美国乳癌病例中占15%左右<ref name=":3" />，在亚洲的乳癌病例中占10-17%<ref name=":4" />。
三阴性乳癌在美国乳癌病例中占15%左右<ref name=":3" />，在亚洲的乳癌病例中占10-17%<ref name=":4" />。该症多发于年轻女性，可能与{{Tsl|en|BRCA1}}[[突变|基因突变]]相关<ref name=":5" />。特定族裔（[[黑人|非洲裔]]、[[西班牙裔]]）等群体呈现高发，可能与较差[[社会经济地位]]相关<ref name=":5">{{Cite journal|title=Triple-Negative Breast Cancer: An Unmet Medical Need|url=http://theoncologist.alphamedpress.org/content/16/suppl_1/1|last=Gianni|first=Luca|last2=Hudis|first2=Clifford A.|date=2011-01-01|journal=The Oncologist|issue=Supplement 1|doi=10.1634/theoncologist.2011-S1-01|volume=16|pages=1–11|language=en|issn=1083-7159|pmid=21278435}}</ref>。肥胖亦为该疾病的[[风险因子]]，[[身高體重指數|身高体重指数]]较高者易患病<ref>{{Cite journal|title=Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis|url=https://doi.org/10.1007/s10549-012-2339-3|last=Pierobon|first=Mariaelena|last2=Frankenfeld|first2=Cara L.|date=2013-01-01|journal=Breast Cancer Research and Treatment|issue=1|doi=10.1007/s10549-012-2339-3|volume=137|pages=307–314|language=en|issn=1573-7217}}</ref>。对于不到40岁的女性群体，长期口服避孕药物是否促进该型癌症发生目前试验数据的结果尚存矛盾<ref name=":6">{{Cite journal|title=Triple-negative breast cancer: epidemiological considerations and recommendations|url=https://academic.oup.com/annonc/article/23/suppl_6/vi7/173019|last=Boyle|first=P.|date=2012-08-01|journal=Annals of Oncology|issue=suppl_6|doi=10.1093/annonc/mds187|volume=23|pages=vi7–vi12|language=en|issn=0923-7534}}</ref>。风险因子的研究仍然受限于对三阴性乳癌的分型研究与人口统计数据<ref name=":6" />。


== 参考文献 ==
== 参考文献 ==

2019年5月15日 (三) 07:45的版本

三陰性乳癌（英語：Triple-negative breast cancer，缩写为TNBC），也称三阴性乳腺癌，是指缺乏雌激素受体（英语：Estrogen receptor）（ESr或Er）、孕酮受体（Pr）表达与缺乏表皮生长因子受体-2（HER）过表达或者增殖的乳癌[1]，临床上一般通过免疫组化确定[2]。这三个特征常见于其它乳癌中，却少见于此分型中[1]，如激素治疗等在内的常见乳癌治疗方案往往针对这三类受体，因而对三阴性乳癌患者一般无效[3]。目前主要采取化疗对该癌症包括转移期在内各个阶段进行治疗[4]。虽然三阴性乳腺癌患者对于化疗有反应，但是对生存预期改善不大[1]，与其它药物进行联合治疗已经被临床试验证实有效[5]。在美国，超50%的可选择手术的患者选择了乳房切除术[3]。

三阴性作为一种侵袭性表型，主要表现为基底样或正常乳腺样肿瘤[2]，90%为单灶性浸润性导管癌[2]。该型癌症易发转移，复发较多且较早，缺乏获批准（英语：Approved drug）的靶向治疗方法[3]。该型癌症具有高度异质性，因此可能并非单一疾病，而是不同疾病之集合[6]，依据组织学、细胞起源、突变、转移潜能、疾病进展、治疗反应和临床结果等，还可以分出可以采取不同治疗策略的亚型[1][7]，如针对BCRA突变的患者已经出现PARP抑制剂（英语：PARP inhibitor）等靶向治疗药物[8][9][10]。不同亚型对药物的反应也不同，如病人无BRCA1/2突变或有肿瘤浸润淋巴细胞浓度增加，则已有试验证实卡铂联合紫杉醇进行新辅助（英语：Neoadjuvant therapy）化疗效果更好[11][12]。对于不同亚型的预后也会有所差异，诺丁汉预后指数可以帮助进行预后判断，但需要更激进治疗者除外[13]。

三阴性乳癌在美国乳癌病例中占15%左右[3]，在亚洲的乳癌病例中占10-17%[7]。该症多发于年轻女性，可能与BRCA1基因突变相关[14]。特定族裔（非洲裔、西班牙裔）等群体呈现高发，可能与较差社会经济地位相关[14]。肥胖亦为该疾病的风险因子，身高体重指数较高者易患病[15]。对于不到40岁的女性群体，长期口服避孕药物是否促进该型癌症发生目前试验数据的结果尚存矛盾[16]。风险因子的研究仍然受限于对三阴性乳癌的分型研究与人口统计数据[16]。

参考文献

  1. ^ 1.0 1.1 1.2 1.3 Minckwitz, Gunter von; Tutt, Andrew; Liedtke, Cornelia; Denkert, Carsten. Molecular alterations in triple-negative breast cancer—the road to new treatment strategies. The Lancet. 2017-06-17, 389 (10087): 2430–2442. ISSN 0140-6736. PMID 27939063. doi:10.1016/S0140-6736(16)32454-0 （英语）. 
  2. ^ 2.0 2.1 2.2 Kumar, Pankaj; Aggarwal, Rupali. An overview of triple-negative breast cancer. Archives of Gynecology and Obstetrics. 2016-02, 293 (2): 247–269. ISSN 0932-0067. doi:10.1007/s00404-015-3859-y （英语）. 
  3. ^ 3.0 3.1 3.2 3.3 Sharma, Priyanka. Biology and Management of Patients With Triple-Negative Breast Cancer. The Oncologist. 2016-09, 21 (9): 1050–1062. ISSN 1549-490X. PMC 5016071 可免费查阅. PMID 27401886. doi:10.1634/theoncologist.2016-0067. 
  4. ^ Gadi, Vijayakrishna K.; Davidson, Nancy E. Practical Approach to Triple-Negative Breast Cancer. Journal of Oncology Practice. 2017-05-01, 13 (5): 293–300. ISSN 1554-7477. doi:10.1200/JOP.2017.022632. 
  5. ^ Chalakur-Ramireddy, Naveen K.R.; Pakala, Suresh B. Combined drug therapeutic strategies for the effective treatment of Triple Negative Breast Cancer. Bioscience Reports. 2018-01-30, 38 (1). ISSN 0144-8463. PMC 5789156 可免费查阅. PMID 29298879. doi:10.1042/BSR20171357. 
  6. ^ Foulkes, William D.; Smith, Ian E.; Reis-Filho, Jorge S. Triple-Negative Breast Cancer. New England Journal of Medicine. 2010, 363 (20): 1938–1948. doi:10.1056/Nejmra1001389. 
  7. ^ 7.0 7.1 Wang, Chao; Kar, Shreya; Lai, Xianning; Cai, Wanpei; Arfuso, Frank; Sethi, Gautam; Lobie, Peter E.; Goh, Boon C.; Lim, Lina H.K. Triple negative breast cancer in Asia: An insider’s view. Cancer Treatment Reviews. 2018-01, 62: 29–38. doi:10.1016/j.ctrv.2017.10.014 （英语）. 
  8. ^ Robson, Mark; Im, Seock-Ah; Senkus, Elżbieta; Xu, Binghe; Domchek, Susan M.; Masuda, Norikazu; Delaloge, Suzette; Li, Wei; Tung, Nadine. Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. New England Journal of Medicine. 2017-08-10, 377 (6): 523–533. ISSN 0028-4793. PMID 28578601. doi:10.1056/NEJMoa1706450. 
  9. ^ 佩妮. PARP抑制剂在三阴性乳腺癌中的应用. 药渡. 2018-03-23 [2019-05-14] –通过新浪医药. 
  10. ^ Litton, Jennifer; Hannah, Alison; Blum, Joanne; Tudor, Iulia; Markova, Denka; Miguel, Martin; Gonçalves, Anthony; Hurvitz, Sara A.; Ettl, Johannes. A phase 3 trial comparing talazoparib, an oral PARP inhibitor, to physician’s choice of therapy in patients with advanced breast cancer and a germline BRCA mutation: EMBRACA subgroups by age. The Breast. 2018-10-01, 41: S12. ISSN 0960-9776. doi:10.1016/j.breast.2018.08.034 （英语）. 
  11. ^ 钱多乐. 三阴性乳腺癌新辅助化疗标准 柳叶刀揭示卡铂能带来什么？. 医脉通肿瘤科. 2018-03-05 [2019-05-15] –通过健康界. 
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