Meme kanserinde moleküler alt tiplere göre cerrahi tedavi yaklaşımları

Meme kanseri oldukça sık görülen bir hastalıktır ve farklı biyolojik davranışlar sergileyen heterojen bir tümördür. cDNA mikrodizin çalışması ve immünohistokimyasal belirteçlere dayanarak meme kanseri 4 temel alt tipe ayrılmıştır: luminal A (estrojen reseptör [ER] pozitif ve/ veya progesteron reseptör [PR] pozitif, human epidermal growth factor receptor 2 [HER2] negatif, Ki67 ekspresyonu düşük; luminal B (ER pozitif ve/veya PR pozitif, HER2 pozitif, Ki67 yüksek); HER2-pozitif (ER negatif, PR negatif, HER2 pozitif); ve bazal tip (ER negatif, PR negatif, HER2 negatif, cytokeratin 5/6 pozitif). Son yıllarda bazı çalışmalarda meme kanserinin bu moleküler alt tipleri ile sağ kalım arasındaki ilişki araştırılmıştır. Genel olarak luminal tip tümörler daha iyi prognoza sahip iken, bazal tip ve HER2 pozitif tip meme kanserinde nüks hastalık gelişimi daha fazladır. Yeni çalışmalar meme kanserli olgularda bu farklı alt tipleri arasında tedavi stratejilerinde belirgin farklılıkları göstermektedir. Bu derlemede moleküler alt tiplere göre yapılan bu yeni sınıflamanın cerrahi tedavi yaklaşımları üzerine yararı olup olmadığı ve bu moleküler alt tipler ile meme kanseri prognozu arasında ilişki tartışılmıştır.

Surgical treatment approaches according to the molecular subtypes in breast cancer

Breast cancer is a very common disease and heterogeneous tumor that exhibits very different biological behavior. Based on cDNA microarrays and immunohistochemical markers, breast cancer is classified into four distinct subtypes: luminal A(estrogen receptor [ER] positive and/or progesterone receptor [PR] positive, human epidermal growth factor receptor 2 [HER2] negative, Ki67 low); luminal B (ER positive and/ or PR positive, HER2 positive, Ki67 high); HER2-enriched (ER negative, PR negative, HER2 positive); and basal-like (ER negative, PR negative, HER2 negative, cytokeratin 5/6 positive). Several studies have investigated the association between survival and the molecular subtypes of breast cancer. It is generally reported that luminal type tumors have a more favorable prognosis but, basallike and HER2-enriched types more likely to develop the recurrence. Recent reports have examined the identified significant difference in treatment strategies in patients of varying molecular subtypes of breast cancer. In this review we discuss whether the new classification according to the molecular subtypes is useful for the surgical treatment approaches and the correlation between the molecular subtypes and prognosis of breast cancer.

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