早期乳腺癌辅助治疗的进展和争议

doi:10.19401/j.cnki.1007-3639.2025.03.001

摘要/Abstract

摘要：

乳腺癌是全球女性常见的恶性肿瘤之一，随着筛查和诊断技术的进步，越来越多的乳腺癌患者得以在早期即被确诊。不同类型的早期乳腺癌辅助治疗方案不尽相同，但近年来，其治疗策略的重心均在于根据患者的个体风险特征，在最大化疗效的同时避免过度治疗。对于激素受体（hormone receptor，HR）阳性乳腺癌，细胞周期蛋白依赖性激酶（cyclin-dependent kinase，CDK）4/6抑制剂的引入显著改善了中高危患者的预后；同时，基于基因检测的豁免化疗策略也在不断推进。然而，哪些患者可从CDK4/6抑制剂强化治疗中获益，以及多基因检测提示中危的绝经前患者是否有化疗获益等问题仍存在争议。在人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）阳性乳腺癌中，抗HER2靶向治疗和新一代抗体药物偶联物药物为患者提供了更有效的治疗选择。但如何筛选适合双靶治疗的人群仍在探索中，新辅助治疗后未达到病理学完全缓解的患者如何选择后续强化治疗方案当前也尚未达成共识。对于三阴性乳腺癌，在传统辅助治疗不断优化的同时，免疫治疗在新辅助治疗及辅助治疗阶段的应用也取得了显著进展。然而，免疫治疗的最佳获益人群如何界定，以及免疫治疗的优化策略仍是当前研究的重要方向。本文针对早期乳腺癌辅助治疗的进展和争议进行综述，以期为当前临床实践提供参考，也为未来深入研究提供思路。

关键词: 早期乳腺癌, 辅助治疗, 临床研究, 研究进展

Abstract:

Breast cancer is one of the common malignant tumors among women worldwide, and with advances in screening and diagnostic technology, more and more breast cancer patients are being diagnosed at an early stage. Adjuvant treatment options for different types of early-stage breast cancer vary. In recent years, the development of treatment strategies has focused on maximizing the efficacy of treatment while avoiding over-treatment based on the patient’s individual risk profile. For hormone receptor (HR)-positive breast cancer, the introduction of cell cyclin-dependent kinase (CDK)4/6 inhibitors has significantly improved the prognosis of intermediate- and high-risk patients. Meanwhile, chemotherapy de-escalation strategies based on genetic testing are also advancing. However, controversies remain regarding which patients can benefit from CDK4/6 inhibitor-enhanced therapy and whether premenopausal patients with intermediate-risk classification from multi-gene assays can gain benefits from chemotherapy. In human epidermal growth factor receptor 2 (HR)-positive breast cancer, anti-HER2 targeted therapies and novel antibody-drug conjugate provide more effective treatment options. However, how to screen the optimal population for dual-targeted therapy is still under exploration, and currently there is no consensus on how to select subsequent intensified regimens for patients who fail to achieve pathological complete response after neoadjuvant therapy. For triple-negative breast cancer, while traditional adjuvant therapy has been continuously optimized, the application of immunotherapy in the neoadjuvant and adjuvant phases has also made significant progress. Nevertheless, the definition of the optimal population to benefit from immunotherapy and the optimization strategy of immunotherapy are still key areas of ongoing research. This review summarized the advancements and controversies in adjuvant therapy for early breast cancer, aiming to provide references for current clinical practice and insights for future research directions.

Key words: Early breast cancer, Adjuvant treatment, Clinical research, Research progress

中图分类号:

R737.9

王稚晴, 刘西禹, 范蕾. 早期乳腺癌辅助治疗的进展和争议[J]. 中国癌症杂志, 2025, 35(3): 255-262.

WANG Zhiqing, LIU Xiyu, FAN Lei. Advances and controversies in the adjuvant treatment of early breast cancer[J]. China Oncology, 2025, 35(3): 255-262.

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