1~2枚前哨淋巴结阳性早期乳腺癌患者治疗策略降阶梯新理念

doi:10.19401/j.cnki.1007-3639.2023.06.002

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (6): 560-565.doi: 10.19401/j.cnki.1007-3639.2023.06.002

1~2枚前哨淋巴结阳性早期乳腺癌患者治疗策略降阶梯新理念

毕钊(), 王永胜()

山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心，山东第一医科大学（山东省医学科学院），山东济南 250117

收稿日期:2022-12-09 修回日期:2023-05-04 出版日期:2023-06-30 发布日期:2023-07-26
通信作者: 王永胜（ORCID: 0000-0001-6252-684X），主任医师，山东省肿瘤医院乳腺病中心主任。
作者简介:毕钊（ORCID: 0000-0001-9546-1704），博士，住院医师。
王永胜，二级教授、博士研究生导师，现任山东省肿瘤医院大外科主任，山东省肿瘤医院乳腺病中心主任。担任中国抗癌协会乳腺癌专业委员会副主任委员，中国抗癌协会国际医疗交流分会副主任委员，中国临床肿瘤学会乳腺癌专家委员会常务委员，中国医师协会肿瘤分会乳腺癌学组副组长，中华医学会肿瘤学分会乳腺癌学组委员，国家卫生健康委乳腺癌诊疗规范专家组成员，全球乳腺癌大会国际指导专家委员会成员，山东省抗癌协会靶向治疗分会主任委员。于国内率先开展乳腺癌保留乳房手术、前哨淋巴结活检替代腋窝淋巴结清扫术、乳腺病变微创诊断等研究，作为组长单位和首席专家，牵头开展了中国临床早期乳腺癌前哨淋巴结活检替代腋窝清扫术的多中心研究、乳腺癌内乳区前哨淋巴结活检术的多中心前瞻性临床验证研究和新型示踪技术引导乳腺癌内乳前哨淋巴结活检的多中心前瞻性临床研究，研究成果已达到国际领先水平，并参与多项国际和国内乳腺癌Ⅲ期临床研究。以第一作者或通信作者发表论文200余篇，其中在SCI收录期刊上发表论文60余篇，出版专著（译著等）共4部，授权国家发明专利2项，获奖成果共5项，其中国家级1项、部（省）级4项，作为主要负责人承担国家级项目4项、部（省）级项目3项。

New concept of de-escalation management strategy in breast cancer patients with 1-2 positive sentinel lymph nodes

BI Zhao(), WANG Yongsheng()

Department of Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China

Received:2022-12-09 Revised:2023-05-04 Published:2023-06-30 Online:2023-07-26

摘要/Abstract

摘要：

随着乳腺癌前哨淋巴结活检（sentinel lymph node biopsy，SLNB）的广泛应用，乳腺癌全身治疗与区域处理理念也随之得到优化。SLNB时代，1 ~ 2枚前哨淋巴结（sentinel lymph node，SLN）阳性患者豁免腋窝淋巴结清扫（axillary lymph node dissection，ALND）比例逐渐增加，腋窝区域处理降阶梯理念降低了患者术后并发症的发生率，改善了患者的生活质量；多基因检测与Z0011/AMAROS标准的联合应用，使得1 ~ 2枚SLN阳性豁免ALND患者能够精准接受多基因检测，不仅能使腋窝区域处理降阶梯，而且也能让全身辅助治疗降阶梯，从而使患者获得真正意义上的个体化双降阶梯治疗；1 ~ 2枚SLN阳性豁免ALND患者区域淋巴结放疗靶区的确定应充分评估腋窝残留肿瘤负荷，并结合临床复发风险因素来优化。SLNB时代，全身治疗和放疗的综合应用，将作为有力手段，合理缩小手术范围并减少并发症，充分扩大疗效与患者生活质量的“净获益”。本文就1 ~ 2枚SLN阳性早期乳腺癌患者治疗策略降阶梯理念优化进行综述。

关键词: 乳腺癌, 前哨淋巴结活检, 多基因检测, 放疗

Abstract:

In the era of sentinel lymph node biopsy (SLNB), the axillary management concept that 1-2 positive sentinel lymph node (SLN) could safely omit axillary lymph node dissection (ALND) are gradually being accepted by more and more patients. The omission of ALND is safe with no difference in regional recurrence in early breast cancer patients with limited SLN involvement. With the effective support and supplement of systemic therapy and radiotherapy, the management concept of axilla surgery is developing in a de-escalating trend. The combined application of multi-gene tests and ACSOG Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In clinical practice, it is necessary to combine the residual tumor burden of regional lymph nodes to formulate the optimal irradiation fields in patients with 1-2 positive SLNs without ALND. In the era of SLNB, we can make full use of the benefits of systemic therapy and radiotherapy to reasonably reduce the scope of surgery and complications, therefore expand the "net benefit" of efficacy and quality of life. This paper reviewed the optimization of the de-escalation strategy concept for systemic and regional management in patients with 1-2 positive SLNs.

Key words: Breast cancer, Sentinel lymph node biopsy, Multi-gene test, Radiotherapy

中图分类号:

R737.9

毕钊, 王永胜. 1~2枚前哨淋巴结阳性早期乳腺癌患者治疗策略降阶梯新理念[J]. 中国癌症杂志, 2023, 33(6): 560-565.

BI Zhao, WANG Yongsheng. New concept of de-escalation management strategy in breast cancer patients with 1-2 positive sentinel lymph nodes[J]. China Oncology, 2023, 33(6): 560-565.

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1~2枚前哨淋巴结阳性早期乳腺癌患者治疗策略降阶梯新理念

New concept of de-escalation management strategy in breast cancer patients with 1-2 positive sentinel lymph nodes

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