These special phenotypes substantially differ in terms of biological behavior and clinical course. Other histologic “ special types” (HST), such as metaplastic, apocrine, lobular and adenoid cystic carcinomas, are still included among TNBC. TNBC comprehends tumors with different clinico-pathological features and genetic-molecular alterations, and it is prevalently histological categorized as IBC-NST. TNBC is most prevalent in young women, < 50 years of age, showing aggressive clinical behavior, high histological grade and poor prognosis, and is responsible for about 25% of BC-related deaths. Particularly, ER/PR/HER2 negative immunostain defines the Triple Negative subtype, which accounts for 10 -20% of all invasive breast cancer types. Interestingly, BC subtyping by immunohistochemistry (IHC) is concordant with gene expression profiles, therefore having significant clinical utility. So far, invasive breast cancer has been classified according to histological features and immunohistochemical expression of estrogen receptors (ER), progesterone receptors (PR) and HER2 overexpression and/or HER2 gene amplification. Recently, a marked molecular heterogeneity of breast cancer has also been demonstrated by gene expression profiling studies, which identified four major BC “ intrinsic” subtypes, including luminal A, luminal B, HER2-enriched, and basal-like, showing variable biological, clinical behaviors and response to treatment. Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.īreast cancer (BC) is a heterogeneous disease, which encompasses various entities showing significant differences in morphologic and prognostic features, as well as in therapeutic options. TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. TNBC “ special types” showed significant differences for several clinico-pathological features when compared to IBC-NST. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 19 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing “ special types” to high-grade invasive breast carcinomas of no special type (IBC-NST). Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity.
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