中国普外基础与临床杂志

中国普外基础与临床杂志

新辅助化疗后乳腺癌保乳手术问题现状

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目的 探讨新辅助化疗后乳腺癌的病灶退缩模式及其影像学评估方式,新辅助化疗后行保乳手术的适应证,病灶切除范围、切缘选择、前哨淋巴结活检术(SLNB)及腋窝淋巴结处理问题。 方法 检索国内外关于新辅助治疗后保乳手术的相关文献并作综述。 结果 新辅助化疗后行保乳手术提高了保乳手术率,改善了乳腺癌患者术后的生活质量,同时其总生存率较乳房全切除者无明显差异。新辅助化疗后肿瘤的退缩模式及其相关因素尚待进一步研究。目前新辅助化疗后保乳手术的适应证仍然主要参考早期乳腺癌的保乳适应证,病灶切除范围则更倾向于按化疗后肿瘤病灶范围,广泛接受的切缘阴性为切缘没有肿瘤细胞累及。SLNB 及根据 SLNB 结果处理腋窝淋巴结在新辅助化疗后保乳手术中的应用尚存在部分争议,从总体来讲 SLNB 仍被认为是有必要的,但应充分保障活检技术的准确性。 结论 目前新辅助化疗后保乳手术被认为是安全和有效的,但需在与患者充分沟通局部复发率、规范的局部治疗、术后标准放疗、全身辅助治疗、定期随访等多项保障下慎重进行。

Objective To explore the tumor shrinking pattern, the image evaluation methods of the residual lesions after neoadjuvant chemotherapy, and the indications, the resection range, the surgical margins, the management of sentinel lymph node biopsy (SLNB) and axillary lymph nodes of breast conserving surgery after neoadjuvant chemotherapy. Methods Domestic and foreign literatures about the breast conserving surgery after neoadjuvant chemotherapy were collected and reviwed. Results Breast conserving surgery after neoadjuvant chemotherapy raised the rate of breast conserving surgery and improved the postoperative life quality of patients, while the overall survival rate had no significant difference compared with mastectomy. Tumor shrinking pattern and its related factors after neoadjuvant chemotherapy remain required further study. At present, the indications for breast conserving surgery after neoadjuvant chemotherapy still mainly refered to that for early stage breast cancer. Resection range was more recognized to the scope of residual tumor lesions after chemotherapy. The margins were more widely accepted as which were without tumor involved. Although there were some controversies about the use of SLNB and the management of axillary lymph nodes based on the results of SLNB in breast conserving surgery after neoadjuvant chemotherapy, it was still considered necessary at the basis of the accurate biopsy technique acquired. Conclusions At present, breast conserving treatment after neoadjuvant chemotherapy is considered safe and effective. However, it is necessary to proceed cautiously under the conditions of adequate communication of local recurrence rate, standardized local treatment, standard postoperative radiotherapy, systemic adjuvant therapy, and regular follow-up.

关键词: 乳腺癌; 新辅助化疗; 保乳手术; 综述

Key words: breast cancer; neoadjuvant chemotherapy; breast conserving surgery; review

引用本文: 张玲菡, 柳梅, 龚灿, 王晓东. 新辅助化疗后乳腺癌保乳手术问题现状. 中国普外基础与临床杂志, 2018, 25(2): 154-160. doi: 10.7507/1007-9424.201712027 复制

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