Retornamos ao início: cirurgiões e oncologistas quando tratam de cânceres de mama, necessitam de informações que indiquem com a maior aproximação possível, a natureza biológica do caso que estão abordando, a provável evolução e, a possível resposta às opções de tratamento. No tocante aos Tumores Triplo Negativos, percebem-se tentativas de aperfeiçoamento das classificações, mediante a conjugação dos aspectos moleculares, anatômicos e histológicos, na busca da individualização das pacientes. Informações de simples aquisição e baixo custo, como as citoqueratinas basais e o EGFR, devem fazer parte dos estudos já rotineiros de imunoistoquímica, porque auxiliam, com razoável acurácia, a identificação dos
tumores basais. Descrições da histo-morfologia passíveis de otimização, como: bordas e núcleos tumorais, acelularidade e necrose central (“CAZ”), multifocalidade, multicentricidade e infiltrado linfocitário graduado, são indicativas de resposta (ou não) à QT, principalmente se afastados aspectos de metaplasias sarcomatosas, secundárias aos fenômenos de transição epitélio mesenquimal, já suficientemente identificados e reconhecidos. O diálogo das equipes multidisciplinares que tratam do câncer de mama, certamente será ampliado quando se solicitarem aos patologistas maior detalhamento desses aspectos, com o fito de evitar tratamentos citotóxicos em tumores que não responderão, ou o farão de forma efêmera. Há por outro lado, uma parcela de TTN para a qual não se tem o tratamento-alvo, e os recursos de adjuvância conhecidos também não funcionam. Identificar essas mulheres ainda na fase de planejamento terapêutico é útil, até porque talvez sejam casos que exigirão cirurgias mais amplas e radicais; e eventualmente, sem o uso de QT. Dados adicionais auxiliam o encaminhamento das condutas, e dão aos profissionais segurança para o diálogo com a paciente e familiares.
7 - CONCLUSÕES
A) Nesta pesquisa as portadoras de Tumores Triplo Negativos apresentaram diferenças sociodemográficas marcantes em relação às Não triplo Negativas, já que houve significativo acúmulo de pacientes não brancas e predomínio de baixa e média escolaridade dentre as mesmas. Demonstraram uma dependência maior dos serviços públicos de saúde.
B) Os Tumores Triplo Negativos, na população estudada, mostraram-se mais graves ao diagnóstico, com dimensões proporcionalmente maiores, axilas mais comprometidas e estadiamento mais avançado. O grau tumoral elevado (III) foi muito mais frequente que nos NTN, bem como outros indicadores de agressividade tumoral como o Ki 67, o P53 elevado e a multifocalidade. O infiltrado linfocitário se mostrou frequente e, na análise univariada, representou fator de risco para a sobrevida dos TTN.
C) A sobrevida global, foi significativamente inferior nas portadoras de Tumores Triplo Negativos, apesar de tratamentos cirúrgicos mais radicais, e maior proporção de tratamentos quimioterápicos utilizados.
D) A sobrevida livre de doença foi significativamente inferior nas portadoras de tumores Triplo Negativos. As recorrências, além de mais comuns nas pacientes TTN, foram precoces, 70% delas ocorrendo em até 24 meses após o tratamento.
E) A classificação molecular por meio da imunoistoquímica foi capaz de selecionar, na população estudada, uma parcela de portadoras de Tumores Triplo Negativos, que se mostraram como neoplasias especiais, de pior prognóstico, candidatas a tratamentos diferenciados.
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