Subtipos moleculares del cáncer de mama: implicaciones pronósticas y características clínicas e inmunohistoquímicas

Abstract

Breast carcinomas are a heterogeneous group of tumours, in both their clinical behavior and their prognosis. The aim of this article is to classify breast carcinomas according to molecular subtypes by means of immunohistochemical markers and to analyse the clinicopathological and immunohistochemical characteristics and the patterns of survival and relapse of the different subtypes. Two hundred and seventy-two patients diagnosed with breast cancer were classified into five subtypes: breast carcinomas of the basal type, HER2 type, luminal A type, luminal B type and normal. The most frequent breast carcinomas were: luminal A type carcinomas (62.5%), luminal B type carcinomas (18%), HER2 type carcinomas (9.9%), basal type carcinomas (8.4%) and normal phenotype carcinomas (1.4%). Significantly and with greater frequency, the luminal type breast carcinomas proved to be well differentiated tumours, of small tumoral size, with negative axillary ganglions, at an early stage at the time of diagnosis, with high levels of BCL-2 and a low Ki-67 proliferation index. On the contrary, the basal type and HER2 carcinomas presented larger tumours, poorly differentiated, greater ganglionar involvement and more advanced stages at the time of diagnosis. They expressed high Ki-67 proliferation indexes with greater frequency and were the subtypes that showed a worse prognosis on global survival and progression-free survival curves. Breast cancer classification based on immunohistochemical (IHC) parameters makes a better prognostic definition possible. Both the basal type and the HER2 type breast carcinomas present more unfavourable histopathological and IHC characteristics, as well as a worse survival and less relapse time, while the luminal type breast carcinomas show more benign characteristics and a better prognosis.