Kumar Pankaj, Aggarwal Rupali
Department of Radiation Oncology, Max Super Speciality Hospital, Phase-6, Mohali, 160055, Punjab, India.
Department of Radiation Oncology, Indus Super Speciality Hospital, Phase-1, Mohali, 160055, Punjab, India.
Arch Gynecol Obstet. 2016 Feb;293(2):247-69. doi: 10.1007/s00404-015-3859-y. Epub 2015 Sep 4.
Triple-negative breast cancer (TNBC) is a heterogeneous group of tumors comprising various breast cancers simply defined by the absence of estrogen receptor, progesterone receptor and overexpression of human epidermal growth factor receptor 2 gene. In this review, we discuss the epidemiology, risk factors, clinical characteristics and prognostic variables of TNBC, and present the summary of recommended treatment strategies and all other available treatment options.
We performed a systematic literature search using Medline and selected those articles which seemed relevant for this review. In addition, the ClinicalTrials.gov was also scanned for ongoing trials.
TNBC accounts for 10-20 % of all invasive breast cancers and has been found to be associated with African-American race, younger age, higher grade and mitotic index, and more advanced stage at diagnosis. Locoregional treatment is similar to other invasive breast cancer subtypes and involves surgery-mastectomy with or without adjuvant radiotherapy or breast conservation followed by adjuvant radiotherapy. Due to lack of drug-targetable receptors, chemotherapy is the only recommended systemic treatment to improve disease outcome. TNBC is sensitive to chemotherapy as demonstrated by high pathological complete response rates achieved after neoadjuvant chemotherapy, and this approach also allows for breast-conserving surgery. The peak risk of relapse is at 3 years after surgery, thereafter recurrence risk rapidly decreases. Survival after metastatic relapse is shorter as compared to other breast cancer subtypes, treatment options are few and response rates are poor and lack durability. Important molecular characteristics have now been identified that can subdivide this group of breast cancers further and can provide alternative systemic therapies.
To improve therapeutic outcome of TNBC, reliable predictive biomarkers and newer drugs against the known molecular pathways are required.
三阴性乳腺癌（TNBC）是一组异质性肿瘤，包括各种仅因缺乏雌激素受体、孕激素受体以及人表皮生长因子受体2基因过表达而定义的乳腺癌。在本综述中，我们讨论了TNBC的流行病学、危险因素、临床特征和预后变量，并总结了推荐的治疗策略以及所有其他可用的治疗选择。
我们使用Medline进行了系统的文献检索，并选择了那些似乎与本综述相关的文章。此外，还检索了ClinicalTrials.gov上正在进行的试验。
TNBC占所有浸润性乳腺癌的10%-20%，已发现其与非裔美国人种族、较年轻的年龄、更高的分级和有丝分裂指数以及诊断时更晚期的分期相关。局部区域治疗与其他浸润性乳腺癌亚型相似，包括手术——乳房切除术（有或无辅助放疗）或保乳手术加辅助放疗。由于缺乏可药物靶向的受体，化疗是唯一推荐的改善疾病预后的全身治疗方法。TNBC对化疗敏感，新辅助化疗后获得的高病理完全缓解率证明了这一点，而且这种方法还允许进行保乳手术。复发的高峰风险在术后3年，此后复发风险迅速降低。与其他乳腺癌亚型相比，转移性复发后的生存率较短，治疗选择较少，缓解率较低且缺乏持久性。现已确定了重要的分子特征，可进一步细分这组乳腺癌，并可提供替代的全身治疗方法。
为了提高TNBC的治疗效果，需要可靠的预测生物标志物和针对已知分子途径的新型药物。
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