摘要
目的总结近年来新辅助化疗(neoadjuvant chemotherapy,NAC)后乳腺癌手术治疗的相关研究,就NAC对乳腺癌手术治疗的影响进行综述。方法查阅国内外有关乳腺癌NAC与手术治疗相关的研究报道,对相关文献进行分析、总结与探讨。结果NAC后部分患者行保乳手术的生存结局和局部复发风险与乳房全切类似,采用影像学引导的微创活检准确预测NAC后乳房病灶病理完全缓解(pathological complete remission,pCR),有望使部分乳腺癌患者在NAC后可以仅接受放射治疗从而豁免乳房手术。对于腋窝淋巴结阳性的患者,应用双示踪剂、三示踪剂和靶向腋窝淋巴结切除技术使得前哨淋巴结活检的检出率和假阴性率达到临床要求,为前哨淋巴结活检安全替代腋窝淋巴结清扫提供了可能。结论NAC是乳腺癌综合治疗的重要组成部分,但对NAC后乳房原发灶以及腋窝淋巴结的局部处理尚有争议,目前临床工作中依然是基于患者的具体情况进行个体化治疗,以求患者得到最佳的局部复发控制和生存获益。
Objective To summarize recent research on the surgical treatment of breast cancer after neoadjuvant chemotherapy(NAC)and to review the impact of NAC on the surgical treatment of breast cancer.Method Relevant studies on NAC and surgical treatment of breast cancer from both domestic and international sources were reviewed.The literatures were analyzed,summarized,and discussed.Results Following NAC,the survival outcomes and risk of local recurrence in patients undergoing breast-conserving surgery were similar to those undergoing mastectomy.The using of image-guided minimally invasive biopsy accurately predicted pathological complete remission(pCR)of breast lesions after NAC,potentially allowed some breast cancer patients to undergo only radiation therapy after NAC,thus avoiding breast surgery.For patients with positive axillary lymph nodes,techniques such as dual-tracer,triple-tracer,and targeted axillary lymph node dissection had achieved clinical requirements in terms of detection rate and false-negative rate of sentinel lymph node biopsy,provided a safe alternative to axillary lymph node dissection.Conclusions NAC is an important component of comprehensive breast cancer treatment.However,there is still controversy regarding the local treatment of the primary breast lesion and axillary lymph nodes after NAC.Currently,individualized treatment based on the specific circumstances of the patient remains the approach in clinical practice,aiming to achieve the optimal control of local recurrence and survival benefits for patients.
作者
杨曦文
陈洁
YANG Xiwen;CHEN Jie(Breast Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2024年第9期1025-1032,共8页
Chinese Journal of Bases and Clinics In General Surgery
关键词
乳腺癌
新辅助化疗
手术
病理完全缓解
腋窝淋巴结
综述
breast cancer
neoadjuvant chemotherapy
surgery
pathological complete remission
axillary lymph nodes
review
