Correlación histopatológica e inmunohistoquimica en el diagnóstico y tratamiento del cáncer de mama, Solca Guayaquil enero 2015- diciembre 2016
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El cáncer de mama representa un grupo de tumores de comportamiento biológico
diverso y presentación clínica variada. Perou y colaboradores identificaron tumores
mamarios con características moleculares y clínicas similares, especificando 4 subtipos:
luminal A, luminal B, HER2 y de tipo basal (triple Negativo). Posteriormente se
determinó que mediante la evaluación inmunohistoquímica (IHQ) del receptor de
estrógeno (RE), receptor de progesterona (RP) y HER2, se podría categorizar dichos
subtipos sin la necesidad de realizar complicadas técnicas moleculares. Esto ha permitido
una apropiada individualización del tratamiento oncoespecífico, por lo tanto el objetivo
general del presente trabajo fue describir la prevalencia de subtipos intrínsecos de cáncer
de mama en una población ecuatoriana, con la finalidad de establecer una asociación con
el tratamiento adecuado.
Se realizó un estudio observacional, analítico, longitudinal, prospectivo, de
recuperación retrospectiva, del tipo cohorte histórico, en pacientes con diagnóstico
oncológico de cáncer de mama atendidas integralmente en el Instituto Oncológico
Nacional SOLCA “Dr. Juan Tanca Marengo”, de la ciudad de Guayaquil, durante el
periodo de enero del 2015 a diciembre del 2016, recuperándose 340 pacientes. La
mediana de edad fue de 52 años. Se presentó 302 casos con tumor unilateral (89%) y 304
casos unifocales (89%). La primera biopsia fue por Tru-cut (128 casos, 38%), para
posteriormente realizar mastectomía como (243 casos, 72%). El tipo ductal infiltrante
fue el más frecuente (297 casos, 87%). El grado histológico mediante la escala de
Nottingham más común fue Grado II (220 casos, 65%).
La expresión de Her2/neu fue positiva en 84 casos (25% de la muestra). Ninguno
de los casos con expresión equívoca (2++) presentó amplificación (SISH). 244 casos
(72%) presentaron expresión de receptores de estrógeno, así como 217 (64%), expresión
de receptores de progesterona. Un Ki-67 alto estuvo presente en 195 casos (58%).
Finalmente, se catalogó 198 casos como Luminal A (58%), 56 casos como Luminal B
(17%), 54 casos como triple negativos (16%) y 32 casos como Her2 enriquecido (9%)
Se evidenció cierta relación entre la presencia de metástasis y el subtipo
intrínseco: Luminal A, Luminal B, Triple negativo y Her2 enriquecido presentaron una
frecuencia de metástasis del 8%, 14%, 17% y 25%, respectivamente (p=0.015)
VI
Respecto a la relación entre el subtipo intrínseco vs. el tratamiento ofertado, el
100% de los casos recibió quimioterapia a base de taxanos. Más del 80% de los casos
Luminal A o B recibieron hormonoterapia (p<0.001), y más del 90% de los casos Her2
enriquecido recibieron Trastuzumab (p<0.001). Los casos Triple negativos recibieron
principalmente taxanos.
Breast cancer represents a group of tumors of diverse biological behavior and varied clinical presentation. Perou et al identified mammary tumors with molecular and clinical characteristics, specifying 4 subtypes: luminal A, luminal B, HER2 and basal (triple Negative ). Subsequently, it was determined that by immunohistochemical (IHC) evaluation of the estrogen receptor (ER), progesterone receptor (PR) and HER2, these intrinsic subtypes could be categorized without the need to perform complicated molecular techniques. This has allowed an appropriate individualization of the oncospecific treatment offered, therefore the general objective of this work was to describe the prevalence of molecular subtypes of breast cancer in an Ecuadorian population, in order to establish an association with the appropriate treatment. An observational, analytical, longitudinal, prospective, retrospective, historical cohort type study was conducted in patients with oncological diagnosis of breast cancer attended integrally in the National Oncological Institute SOLCA "Dr. Juan Tanca Marengo ", from Guayaquil city, during the period from January 2015 to December 2016. 340 patients were recovered. The median age was 52 years. There were 302 cases with unilateral tumor (89%) and 304 unifocal cases (89%). The first biopsy was mainly performed by Tru-cut (128 cases, 38%), to later perform a mastectomy (243 cases, 72%). The infiltrating ductal type was the most frequent (297 cases, 87%). The most common histological grade using the Nottingham scale was Grade II (220 cases, 65%). HER2 / Neu expression was positive in 84 cases (25% of the sample). None of the cases with equivocal expression (2 ++) presented amplification (SISH). 244 cases (72%) had estrogen receptors expression, as well as 217 (64%), progesterone recptors expression. A high Ki-67 was present in 195 cases (58%). Finally, 198 cases were classified as Luminal A (58%), 56 cases as Luminal B (17%), 54 cases as triple negative (16%) and 32 cases as Her2 enriched (9%). There was a certain relationship between the presence of metastasis and the intrinsic subtype: Luminal A, Luminal B, Triple negative and Her2 enriched presented a metastasis frequency of 8%, 14%, 17% and 25%, respectively (p = 0.015).Regarding the relationship between the intrinsic subtype vs. the treatment offered, 100% of the cases received chemotherapy based on taxanes. More than 80% of the Luminal A or B cases VIII received hormone therapy (p <0.001), and more than 90% of the Her2 enriched cases received Trastuzumab (p <0.001). Triple negative cases received mainly taxanes
Breast cancer represents a group of tumors of diverse biological behavior and varied clinical presentation. Perou et al identified mammary tumors with molecular and clinical characteristics, specifying 4 subtypes: luminal A, luminal B, HER2 and basal (triple Negative ). Subsequently, it was determined that by immunohistochemical (IHC) evaluation of the estrogen receptor (ER), progesterone receptor (PR) and HER2, these intrinsic subtypes could be categorized without the need to perform complicated molecular techniques. This has allowed an appropriate individualization of the oncospecific treatment offered, therefore the general objective of this work was to describe the prevalence of molecular subtypes of breast cancer in an Ecuadorian population, in order to establish an association with the appropriate treatment. An observational, analytical, longitudinal, prospective, retrospective, historical cohort type study was conducted in patients with oncological diagnosis of breast cancer attended integrally in the National Oncological Institute SOLCA "Dr. Juan Tanca Marengo ", from Guayaquil city, during the period from January 2015 to December 2016. 340 patients were recovered. The median age was 52 years. There were 302 cases with unilateral tumor (89%) and 304 unifocal cases (89%). The first biopsy was mainly performed by Tru-cut (128 cases, 38%), to later perform a mastectomy (243 cases, 72%). The infiltrating ductal type was the most frequent (297 cases, 87%). The most common histological grade using the Nottingham scale was Grade II (220 cases, 65%). HER2 / Neu expression was positive in 84 cases (25% of the sample). None of the cases with equivocal expression (2 ++) presented amplification (SISH). 244 cases (72%) had estrogen receptors expression, as well as 217 (64%), progesterone recptors expression. A high Ki-67 was present in 195 cases (58%). Finally, 198 cases were classified as Luminal A (58%), 56 cases as Luminal B (17%), 54 cases as triple negative (16%) and 32 cases as Her2 enriched (9%). There was a certain relationship between the presence of metastasis and the intrinsic subtype: Luminal A, Luminal B, Triple negative and Her2 enriched presented a metastasis frequency of 8%, 14%, 17% and 25%, respectively (p = 0.015).Regarding the relationship between the intrinsic subtype vs. the treatment offered, 100% of the cases received chemotherapy based on taxanes. More than 80% of the Luminal A or B cases VIII received hormone therapy (p <0.001), and more than 90% of the Her2 enriched cases received Trastuzumab (p <0.001). Triple negative cases received mainly taxanes
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Neoplasias de la mama, Subtipos intrínsecos, Luminal A, Inmunohistoquímica, Hospital Solca de Guayaquil, Cantón Guayaquil, Ecuador, Histopatología