三阴性乳腺癌的临床病理特征及分子研究进展

Advance of clinicopathological and molecular research of triple negative breast cancer

三阴性乳腺癌(triple negative breast cancer,TNBC)是具有特殊生物学及临床病理学特征的乳腺癌亚型,以雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)均不表达为主要特征。该型乳腺癌组织学分级较高,侵袭性强,除浸润性导管癌外,还包括一些特殊的组织学亚型。TNBC的免疫表型和分子特征与基底样乳腺癌(basal-like breast cancer,BLBC)存在一定相似性。与其他亚型乳腺癌相比,TNBC因缺乏相应靶点而失去了内分泌和靶向治疗的机会,目前以蒽环类为基础的化疗为主,但疗效欠佳,早期局部复发和远处转移率较高,无病生存和总生存率较低,预后较差。同时该组肿瘤具有高度异质性,虽然免疫表型均为三阴性,但形态学、预后及对治疗的反应有很大差别。近年来,TNBC受到乳腺癌临床和病理学界的广泛关注,针对其分子分型以及多种信号通路的靶向药物得到广泛研究。

Triple negative breast cancer （TNBC） is characterized by the lack of expression of hormone receptors, as well as human epidermal growth factor receptor 2 and displays special biological and clinicopathological characteristics. This subtype is aggressive in nature with high histological grade. Besides invasive ductal carcinoma,several special histological types have also been found. The features of the TNBC subgroup roughly parallel those of the basal-like subgroup. Due to the lack of molecular targets, this subgroup has no chance of endocrine treatment and target therapy. Currently, the treatment of TNI3C is dominated by chemotherapy based on anthracycline with suboptimal efficacy. Overall, the prognosis has remained quite poor. Emerging evidence indicates that patients regimens with triple negative breast cancer usually displays high rate of early recurrence and distant metastasis. Both the disease- free survival and overall survival rates are low. Although this subtype which shows same immunohistologic pattern, great heterogeneity still exists within the group causing distinctions in morphology, prognosis, and more importantly, drastically different reactions to same treatment protocol. In recent years, TNBC has been widely concerned by both clinician and pathologist. Several targeted drugs for corresponding signal pathway as well as the subtype of triple negative breast cancer have been widely studied. This article focused on the advances in clinicopathological characteristics, new subtypes and treatment of triple negative breast cancer.