Saraiva Diana P, Guadalupe Cabral M, Jacinto António, Braga Sofia
CEDOC, Nova Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal.
Instituto CUF de Oncologia, Lisbon, Portugal.
ESMO Open. 2017 Sep 14;2(4):e000208. doi: 10.1136/esmoopen-2017-000208. eCollection 2017.
Triple negative breast cancer (TNBC) is a type of breast cancer (BC) that does not express the oestrogen and the progesterone receptors and the human epidermal growth factor receptor type 2 (HER2). Since there are no positive markers to reliably classify TNBC, these tumours are not yet treated with targeted therapies. Perhaps for this reason they are the most aggressive form of breast carcinomas. However, the clinical observation that these patients do not carry a uniformly dismal prognosis, coupled with data coming from pathology and epidemiology, suggests that this negative definition is not capturing a single clinical entity, but several. We critically evaluate this evidence in this paper, reviewing clinical and epidemiological data and new studies that aim to subclassify TNBC. Moreover, evidence on the role of tumour infiltrating lymphocytes (TILs) on TNBC progression, response to chemotherapy and patient outcome have been published. The heterogeneity, observed even at TILs level, highlights the idea that TNBC is much more than a single disease with a unique treatment. The exploration of the immune environment present at the tumour site could indeed help in answering the question 'How many diseases is TNBC' and will help to define prognosis and eventually develop new therapies, by stimulating the immune effector cells or by inhibiting immunological repressor molecules. In this review, we focus on the prospect of the patient's diverse immune signatures within the tumour as potential biomarkers and how they could be modulated to fight the disease.
三阴性乳腺癌（TNBC）是一种乳腺癌（BC），其不表达雌激素受体、孕激素受体以及人表皮生长因子受体2（HER2）。由于没有可靠的阳性标志物来对TNBC进行分类，这些肿瘤目前尚未采用靶向治疗。也许正因如此，它们是最具侵袭性的乳腺癌形式。然而，临床观察发现这些患者的预后并非一致地糟糕，再加上病理学和流行病学数据表明，这种阴性定义所涵盖的并非单一临床实体，而是多种。在本文中，我们对这一证据进行了批判性评估，回顾了临床和流行病学数据以及旨在对TNBC进行亚分类的新研究。此外，关于肿瘤浸润淋巴细胞（TILs）在TNBC进展、化疗反应及患者预后方面作用的证据也已发表。即使在TILs水平观察到的异质性也凸显了这样一种观点，即TNBC远不止是一种具有单一治疗方法的单一疾病。对肿瘤部位存在的免疫环境进行探索确实有助于回答“TNBC是几种疾病”这一问题，并将有助于通过刺激免疫效应细胞或抑制免疫抑制分子来确定预后并最终开发新的治疗方法。在本综述中，我们重点关注肿瘤内患者多样的免疫特征作为潜在生物标志物的前景，以及如何对其进行调节以对抗疾病。
