三陰性乳癌:修订间差异
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该症的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" />。其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" />。多发于年轻女性,可能与{{Tsl|en|BRCA1}}[[突变|基因突变]]相关<ref name=":5" />。[[黑人|非洲裔]]、[[西班牙裔]]等群体在内特定[[族群|族裔]]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|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>。 |
该症的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" />。其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" />。多发于年轻女性,可能与{{Tsl|en|BRCA1}}[[突变|基因突变]]相关<ref name=":5" />。[[黑人|非洲裔]]、[[西班牙裔]]等群体在内特定[[族群|族裔]]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|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>。 |
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== 分型和临床意义 == |
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在美国,免疫组学结果显示激素受体1%阳性以下的乳癌患者视为三阴性患者,过去视为三阴性的对1-10%的阳性表达患者进行激素治疗仍然显示有效<ref>{{Cite journal|title=American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer|author=|url=http://ascopubs.org/doi/10.1200/JCO.2009.25.6529|last=Hammond|first=M. Elizabeth H.|last2=Hayes|first2=Daniel F.|date=2010-06|journal=Journal of Clinical Oncology|issue=16|doi=10.1200/JCO.2009.25.6529|others=|year=|volume=28|page=|pages=2784–2795|language=en|issn=0732-183X|pmc=2881855|pmid=20404251|last3=Dowsett|first3=Mitch|last4=Allred|first4=D. Craig|last5=Hagerty|first5=Karen L.|last6=Badve|first6=Sunil|last7=Fitzgibbons|first7=Patrick L.|last8=Francis|first8=Glenn|last9=Goldstein|first9=Neil S.}}</ref>,但针对三阴性分型的靶向治疗药物是否适用与此类病人难以判断<ref name=":1" />。依照病理组织学、基因组学等,三阴性乳腺癌可以分为若干种分型<ref name=":1" />。 |
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=== 病理组织学 === |
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== 参考文献 == |
== 参考文献 == |
2019年5月15日 (三) 08:57的版本
三陰性乳癌 | |
---|---|
症状 | 组织细胞突变率高、肿瘤分级高、存在坏死和炎症浸润,不同亚型有所差异[1] |
类型 | 乳癌、triple-negative breast neoplasm[*] |
风险因子 | |
診斷方法 | 免疫组化[3] |
治療 | 外科学 放射線療法 化学疗法 靶向治疗 |
预后 | 依照分型有所差异,多数较差 |
盛行率 | 10-20%的乳癌病例 |
分类和外部资源 | |
醫學專科 | 肿瘤学 |
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(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[3]。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[4]。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[5]。虽然化疗可在病理学意义上完全消除许多三阴性乳腺癌患者的肿瘤[1],但因复发率较高,对患者预期生存时间改善不大,这一矛盾现象也被称为“三阴性悖论”[6][7]。与其它药物进行联合治疗已经被临床试验证实有效[8]。在美国,超50%的可选择手术的患者选择了乳房切除术[4]。
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[3],90%为单灶性浸润性导管癌[3]。该型癌症易发转移,复发较多且较早,缺乏获批准的靶向治疗方法[4]。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[9],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][10],如针对BCRA突变的患者已经出现PARP抑制剂等靶向治疗药物[11][12][13]。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化疗效果更好[14][15]。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[16]。
该症的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[17]。其在美国乳癌病例中占15%左右[4],在亚洲的乳癌病例中占10-17%[10]。多发于年轻女性,可能与BRCA1基因突变相关[2]。非洲裔、西班牙裔等群体在内特定族裔呈现高发,可能与较差社会经济地位相关[2]。肥胖亦为该疾病的风险因子,身高体重指数较高者易患病[18]。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[17]。
分型和临床意义
在美国,免疫组学结果显示激素受体1%阳性以下的乳癌患者视为三阴性患者,过去视为三阴性的对1-10%的阳性表达患者进行激素治疗仍然显示有效[19],但针对三阴性分型的靶向治疗药物是否适用与此类病人难以判断[1]。依照病理组织学、基因组学等,三阴性乳腺癌可以分为若干种分型[1]。
病理组织学
参考文献
- ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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).
- ^ 2.0 2.1 2.2 Gianni, Luca; Hudis, Clifford A. Triple-Negative Breast Cancer: An Unmet Medical Need. The Oncologist. 2011-01-01, 16 (Supplement 1): 1–11. ISSN 1083-7159. PMID 21278435. doi:10.1634/theoncologist.2011-S1-01 (英语).
- ^ 3.0 3.1 3.2 3.3 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).
- ^ 4.0 4.1 4.2 4.3 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 . PMID 27401886. doi:10.1634/theoncologist.2016-0067.
- ^ 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.
- ^ Perou, Charles M.; Graham, Mark L.; Sartor, Carolyn I.; Ollila, David W.; Collichio, Frances; Moore, Dominic T.; Gatti, Lisa; Sawyer, Lynda; Dees, E. Claire. The Triple Negative Paradox: Primary Tumor Chemosensitivity of Breast Cancer Subtypes. Clinical Cancer Research. 2007-04-15, 13 (8): 2329–2334. ISSN 1078-0432. PMID 17438091. doi:10.1158/1078-0432.CCR-06-1109 (英语).
- ^ Perou, Charles M.; Graham, Mark L.; Sartor, Carolyn I.; Ollila, David W.; Collichio, Frances; Moore, Dominic T.; Gatti, Lisa; Sawyer, Lynda; Dees, E. Claire. The Triple Negative Paradox: Primary Tumor Chemosensitivity of Breast Cancer Subtypes. Clinical Cancer Research. 2007-04-15, 13 (8): 2329–2334. ISSN 1078-0432. PMID 17438091. doi:10.1158/1078-0432.CCR-06-1109 (英语).
- ^ 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 . PMID 29298879. doi:10.1042/BSR20171357.
- ^ 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.
- ^ 10.0 10.1 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).
- ^ 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.
- ^ 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.
- ^ 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).
- ^ 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.
- ^ Geyer, Charles E.; Liu, Xuan; Symmans, W. Fraser; Rastogi, Priya; Filho, Otto Metzger; Lorenzo, Jose J. Ponce; McIntyre, Kristi; Wolmark, Norman; Sullivan, Danielle. 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. The Lancet Oncology. 2018-04-01, 19 (4): 497–509. ISSN 1470-2045. PMID 29501363. doi:10.1016/S1470-2045(18)30111-6 (英语).
- ^ Albergaria, A.; Ricardo, S.; Milanezi, F.; Carneiro, V. T.; Amendoeira, I.; Vieira, D.; Cameselle-Teijeiro, J.; Schmitt, F. Nottingham Prognostic Index in Triple-Negative Breast Cancer: A reliable prognostic tool?. BMC Cancer. 2011, 11: 299. PMC 3151231 . PMID 21762477. doi:10.1186/1471-2407-11-299.
- ^ 17.0 17.1 Boyle, P. Triple-negative breast cancer: epidemiological considerations and recommendations. Annals of Oncology. 2012-08-01, 23 (suppl_6): vi7–vi12. ISSN 0923-7534. doi:10.1093/annonc/mds187 (英语).
- ^ Pierobon, Mariaelena; Frankenfeld, Cara L. Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis. Breast Cancer Research and Treatment. 2013-01-01, 137 (1): 307–314. ISSN 1573-7217. doi:10.1007/s10549-012-2339-3 (英语).
- ^ Hammond, M. Elizabeth H.; Hayes, Daniel F.; Dowsett, Mitch; Allred, D. Craig; Hagerty, Karen L.; Badve, Sunil; Fitzgibbons, Patrick L.; Francis, Glenn; Goldstein, Neil S. American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer. Journal of Clinical Oncology. 2010-06, 28 (16): 2784–2795. ISSN 0732-183X. PMC 2881855 . PMID 20404251. doi:10.1200/JCO.2009.25.6529 (英语).