Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Milan, Italy.
Breast. 2011 Oct;20 Suppl 3:S153-7. doi: 10.1016/S0960-9776(11)70315-0.
Recent developments in the adjuvant treatment of breast cancer include an increasing attention to systemic therapies prescribed in homogeneous groups of patients according to the higher chance of benefit. A clear consequence of the current adjuvant treatment strategy is the importance of accurate and reliable histopathological assessment. A proper pathological evaluation may effectively support the definition of prognosis and treatment choice in niches of patients diagnosed with special types of breast cancer. Through the identification of special types of breast cancer, that account for up to 25% of all invasive breast carcinomas, it is possible to select patients with a very good prognosis often close to that of the general population (e.g. tubular and pure cribriform carcinoma). Other features, such as those related with invasive classical lobular carcinoma, might have important correlates of responsiveness to therapy other than indicators of outcome. It was in fact demonstrated that the response to primary chemotherapy is significantly lower in invasive lobular carcinoma, if compared with the ductal histotype. However, the use of available information on special types of breast cancer has been limited in tailoring adjuvant therapy, owing to the absence of standardized criteria and partial reproducibility for diagnosis. Moreover, due to the relative rarity of the disease a large number of features that identify for special types of breast carcinomas have today no particular correlation with the prognosis, and limited data are available on the biology of a large number of breast cancer subtypes. The development of more effective therapies for patients with special types of breast cancer requires tailored treatment investigations through international cooperation and should not rely on information predominantly contributed from small retrospective analyses. Examination of patterns of relapse and treatment response within subpopulations in multiple randomized trials is also mandatory to make progress and reach consensus on how to treat individual patients with special types of breast cancer.
近年来，乳腺癌的辅助治疗进展包括越来越关注根据获益可能性更高的原则，对同质患者群体开具的系统治疗。当前辅助治疗策略的一个明显结果是准确可靠的组织病理学评估的重要性。适当的病理评估可以有效地支持在诊断为特殊类型乳腺癌的患者的特定亚组中定义预后和治疗选择。通过识别占所有浸润性乳腺癌的 25%的特殊类型乳腺癌，可以选择预后非常好的患者，这些患者的预后通常接近普通人群（例如管状和纯筛状癌）。其他特征，如与浸润性经典小叶癌相关的特征，除了预后指标外，可能与治疗反应有重要相关性。事实上，与导管组织学类型相比，浸润性小叶癌对原发性化疗的反应明显较低。然而，由于缺乏标准化标准和部分诊断的可重复性，特殊类型乳腺癌的可用信息在辅助治疗的制定中受到限制。此外，由于疾病的相对罕见性，目前许多用于确定特殊类型乳腺癌的特征与预后没有特别的相关性，并且大量乳腺癌亚型的生物学数据有限。为特殊类型乳腺癌患者开发更有效的治疗方法需要通过国际合作进行量身定制的治疗研究，而不应依赖于主要来自小型回顾性分析的信息。在多个随机试验中对亚群内的复发和治疗反应模式进行检查也是取得进展并就如何治疗特殊类型乳腺癌的个别患者达成共识的必要条件。
