最新刊期
卷 32 ， 期 8 ， 2022
- 摘要：According to the latest data released by the Cancer Research Institute of the World Health Organization, breast cancer has replaced lung cancer as the malignant tumor with the highest incidence rate in the world. Triple-negative breast cancer (TNBC) is defined by a lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Compared with other types of breast cancer, TNBC bears the characteristics of high metastasis rate, strong invasiveness and poor prognosis. TNBC is not sensitive to endocrine therapy and anti-HER2 therapy, and chemotherapy is its main systemic treatment. With the vigorous development of genomics, transcriptomics, metabolomics, proteomics, microbiomics technologies and the in-depth study of TNBC molecular subtyping, targeted therapy and immunotherapy drugs, including poly(ADP-ribose) polymerase (PARP) inhibitors, trophoblast cell-surface antigen 2 (TROP-2) antibody-drug conjugate, pembrolizumab, atezolizumab, durvalumab, etc., have provided new therapeutic methods, which are changing the clinical practice and treatment pattern of TNBC. It is believed accurate therapy will become a new direction of development in the future. Based on the molecular subtypes of TNBC, here we summarized the research advances in targeted therapy and immunotherapy of TNBC, in order to provide reference for the precise treatment strategy of TNBC in the future.关键词：Triple-negative breast cancer;Molecular subtypes;Precision therapy;Targeted therapy;Immunotherapy1423|5827|0更新时间：2025-12-31
- 摘要：Regional lymph node status is one of the important prognostic indicators of breast cancer, which can guide the staging and adjuvant treatment strategy. Sentinel lymph node biopsy (SLNB) for breast cancer has developed rapidly over the past three decades, evidence-based medicine class Ⅰ evidence supports that SLNB is a safe and effective axillary staging technique for patients with clinically negative axillary lymph node in early breast cancer. The risk of axillary recurrence and complications in breast cancer patients with negative/few-positive sentinel lymph node omitting axillary lymph node dissection is very low. Locoregional management of breast cancer should consider the metastatic risk of the primary tumor, the efficacy and side effects of systemic therapy, and the efficacy and side effects of locoregional therapy (surgery/radiotherapy). This view has promoted the continuous expansion of the SLNB population. SLNB with neoadjuvant therapy and internal mammary SLNB will further promote the de-escalation therapy, and the ongoing studies of omission of axillary surgery should be anticipated. The era of precision medicine for regional lymph node management of breast cancer has gradually arrived with the development of SLNB. This article evaluated the latest progress of precise regional processing of breast cancer in the sentinel lymph node era, in order to provide reference for clinical doctors.关键词：Breast cancer;Sentinel lymph node biopsy;Axillary lymph node;Internal mammary lymph node382|2883|0更新时间：2025-12-31
- 摘要：Breast cancer is the most common malignant tumor in women worldwide. Recently, the complexity of malignant tumors has been revealed following the rapid expansion of the knowledge system of genomics, and the treatment of tumors has shifted from tumor type-oriented therapy to gene-oriented therapy, which is based on biomarker analysis. Great efforts have proved that tumor molecular profiles from patients are capable to improve the selection of personalized treatment options, as well as monitoring of treatment response, drug resistance and tumor recurrence. Liquid biopsy, a method to analyze the genome and other data contained in tumor-derived materials in body fluids, can obtain detailed information about the characteristics of individual patient's tumors, providing new ideas for precision treatment. In the precise treatment of breast cancer, liquid biopsy can predict survival prognosis, detect minimal residual disease (MRD), monitor treatment efficacy, and play a role in (neo)adjuvant treatment and rescue treatment. Although the research of liquid biopsy in the precise treatment of breast cancer has made remarkable progress, there are still some problems, and more work is needed to further improve the technology. In this paper, we reviewed the research progress of liquid biopsy in the precision therapy of breast cancer in recent years, and the future trend of liquid biopsy is forecasted.关键词：Breast cancer;Precision therapy;liquid biopsy;Circulating tumor cell;ctDNA114|3919|0更新时间：2025-12-31
- 摘要：Breast cancer is the most common malignant tumor in women. Surgery is the main treatment for early breast cancer. At present, great progress has been made in the diagnosis and treatment of early breast cancer. Howover, innovative approaches are still needed to reduce trauma and improve patients' outcomes. With the progress of innovative research on the treatment of breast cancer, non-surgical treatment of breast and axilla has become a research hotspot of treatment of early breast cancer. Microwave ablation, as a minimally invasive and precise local treatment, has the characteristics of speedy ablation, simple operation method, less postoperative complications and so on. At present, microwave ablation has been used to treat early breast cancer, and has achieved clinical efficacy. In addition, some studies have been reported that microwave ablation of early breast cancer is conducive to regulating the tumor immune microenvironment and stimulating the antigen-specific anti-tumor immune effect in the body. This immune effect may be related to the massive release of tumor antigen after microwave ablation. The effect of immunotherapy alone for breast cancer is poor. Some researchers have proposed a scheme to enhance the ablation immune effect through combined immunotherapy, but its specific effect still needs more clinical data support. With more and more research on the immune effect induced by ablation therapy, microwave ablation combined with immune checkpoint inhibitor is expected to become a new strategy in the precise treatment of breast tumor. This article summarized the new progress and future development direction of microwave ablation in local precise treatment of breast cancer.关键词：Breast cancer;Local therapy;Microwave ablation;Immunotherapy55|2790|0更新时间：2025-12-31
Specialists' Commentary
- 摘要：Background and purpose: Endocrine therapy has been one of the routine means of adjuvant therapy for patients with hormone receptor positive after surgery. This study aimed to analyze the factors influencing short-term effect (estrogen suppression effect) and long-term survival (disease-free survival, DFS) in patients with operable breast cancer after ovarian function suppression (OFS) therapy. Methods: DFS data and clinicopathological parameters for 435 patients with estrogen receptor (ER) positive breast cancer who underwent surgery and completed postoperative standard chemotherapy and endocrine therapy (OFS combined with tamoxifen or aromatase inhibitors) between June 2017 to June 2019 were obtained in Fudan University Shanghai Cancer Center. The authors performed univariate logistic regression and multivariate logistic regression to analyze the influencing factors of estrogen suppression, while log-rank test and COX proportional hazards regression model were used to analyze the influencing factors of disease-free survival. Results: The failure rate of estrogen suppression in patients aged ≤35 years was 8.7%, which was significantly higher than that in patients aged 35-40 years (1%, P<0.05). There was no difference in the level of estrogen decline between goserelin and leuprorelin (P>0.05). Endocrine therapy regimen (HR = 0.49, P<0.05), axillary lymph node status (HR = 4.21, P<0.05), and tumor diameter (HR = 2.00, P<0.05) were all influencing factors of patients' DFS; The prognosis of patients with estrogen suppression failure was poor (P = 0.10), but the efficacy of goserelin and leuprorelin in reducing recurrence and metastasis was consistent. Conclusion: Age is an independent risk factor for the failure of short-term estrogen suppression in breast cancer patients treated with OFS. Endocrine therapy regimen, axillary lymph node status and tumor diameter affect the long-term prognosis of patients with ER-positive operable breast cancer. There was no significant difference in the reduction of estrogen levels and long-term disease-free survival between patients with goserelin and leuprorelin.关键词：Breast cancer;Ovarian function suppression;Estrogen-receptor positive;Short-term effect;Long-term survival113|2535|0更新时间：2025-12-31
- 摘要：Background and purpose: Immune checkpoint inhibitors (ICIs) have changed the landscape of cancer treatment during the last 10 years. They have significantly extended survival for patients with malignancy. However, immune-related adverse events (irAE) have been reported and attracted attention with widespread use of ICIs. Currently, there is no reliable biomarker to clinically predict the risk of irAE. This study established a risk prediction model of irAE in tumor patients receiving ICIs based on multiple biological indicators. Methods: A total of 91 patients treated in Zhongshan Hospital of Fudan University from October 2018 to December 2020 were included in the study. Patients included in the study were divided into irAE group and control group according to whether they had grade 2 or higher irAE after receiving ICIs. Biological indicators including serum soluble form of suppression of tumorigenicity-2 (sST2), prognostic nutritional index (PNI) and platelet to lymphocyte ratio (PLR) were collected before and after ICIs treatment. Logistic regression model containing these biomarkers was constructed to predict the risk of irAE. Results: A total of 13 patients in the irAE group. Baseline PNI level, baseline PLR level and post-treatment sST2 peak level showed a significant difference between the irAE group and control group (P<0.05, P<0.05 and P<0.01 respectively). Logistic regression analysis showed that lower baseline PNI level, baseline PLR level and higher post-treatment sST2 peak level were independent risk factors for irAE after ICIs treatment (odds ratio were 0.790, 0.997, and 1.013 respectively). The area under the receiver operating characteristic (ROC) curve was 0.857. Conclusion: Higher sST2 level is an independent risk factor for irAE. The logistic model consisted of sST2, PNI and PLR has a good predictive ability for the risk of irAE after ICIs treatment.关键词：Immune checkpoint inhibitors;Immune-related adverse events;Suppression of tumorigenicity2;Prediction model36|2566|0更新时间：2025-12-31
- 摘要：Background and purpose: Currently, several studies have demonstrated that body mass index (BMI) is a prognostic factor in breast cancer. The study aimed to assess the association pattern of BMI with mortality risk among patients of different age groups. Methods: This retrospective cohort study included the clinical characteristics and survival status of 25 629 patients diagnosed with breast cancer and subsequently hospitalized in Fudan University Shanghai Cancer Center between January 1, 2008 and December 31, 2016. The association between BMI and prognosis of breast cancer patients in different age subgroups was analyzed using Cox proportional hazards regression model with restricted cubic splines adjusting the main prognostic factors. Results: BMI and age were both influencing factors of breast cancer prognosis, and there was a significant interaction (P = 0.011). The pattern of association between risk of death and BMI differed among different age groups. A "J-shaped" association between risk of death and BMI was observed in the patients younger than 35 years, with a BMI of 20.16 kg/m2 corresponding to the lowest risk of death. In the age group of 35-60 years, no significant change in the risk of death was observed in patients with BMI below 23 kg/m2, and the risk of death in patients with BMI above 23 kg/m2 increased with increasing BMI; A "U-shaped" association between risk of death and BMI was observed in the patients older than 60 years, with a BMI of 23.86 kg/m2 being the lowest. The risk of death was more sensitive to changes in BMI in patients aged less than 35 years than in those aged 35-60 years and those aged more than 60 years. Conclusion: BMI and age have a significant interaction in the prognosis of breast cancer when adjusted for potential confounding factors. The association pattern between the risk of death and BMI of patients in different age groups is different. For patients under 35 years old, the lowest risk of death corresponds to BMI at diagnosis of about 20 kg/m2, while for patients over 60 years old, the lowest risk of death corresponds to a BMI at diagnosis of about 24 kg/m2.关键词：BMI;Age;Interaction;Breast cancer80|2544|0更新时间：2025-12-31
- 摘要：Background and purpose: Long noncoding RNA (LncRNA) plays an important role in the development of distant metastasis and drug resistance of tumors, and it is highly expressed in breast cancer tissues and plasma of breast cancer patients. However, the dynamic changes of its expression level in neoadjuvant therapy (NAT) for breast cancer and its relationship with relevant clinicopathological features have not been reported. This study aimed to investigate the predictive value of dynamic changes of plasma long lncRNA H19 in NAT for different molecular types of breast cancer. Methods: Forty-five breast cancer patients undergoing NAT were prospectively selected from January 2021 to December 2021 in the Department of Gynecology, Xiaogan Central Hospital, Wuhan University of Science and Technology. The corresponding treatment plan and cycle were selected for all cases according to their pathological types and general conditions. Real-time fluorescence quantitative polymerase chain reaction (RTFQ-PCR) was used to dynamically detect the expression levels and changes of lncRNA H19 in peripheral blood before NAT, after treatment with NAT for 2, 4 and 6 cycles, and after surgery. The differences and dynamic changes of lncRNA H19 expression levels in different periods of NAT and different molecular types of breast cancer were compared and analyzed, and the efficacy of NAT was evaluated according to pathological features after surgery. Results: LncRNA H19 expression was detected in peripheral blood plasma of 45 breast cancer patients treated with NAT. Among them, 20 patients (44.4%) achieved pathological complete response (pCR), 25 patients (55.6%) did not achieve pCR, and the level of H19 before NAT in patients who achieved pCR was significantly higher compared with non-pCR patients (P<0.05). The expression of H19 in pCR group decreased significantly with the progress of NAT (P<0.05), while H19 expression level in non-pCR group showed no significant downward trend after NAT. In the dynamic changes of NAT, the expression of lncRNA H19 decreased significantly from baseline after 2, 4 and 6 cycles of NAT and after surgery(P<0.05); plasma H19 expression level in human epidermal growth factor receptor 2 (HER2) positive breast cancer patients was significantly higher compared with triple-negative breast cancer (TNBC) patients (P<0.05), but there was no significant difference compared with hormone receptor-positive breast cancer patients (P>0.05), while H19 expression level in TNBC patients was significantly lower compared with patients with hormone receptor-positive type (P<0.05). In the dynamic changes of NAT, the expression level of lncRNA H19 decreased significantly after 2, 4 and 6 cycles of NAT and after surgery (P<0.05). There was no significant difference in tumor size, lymph node status, TNM stage and lncRNA H19 expression between patients with different types of breast cancer (P>0.05), and there were significant differences in tumor residual load and lncRNA H19 expression after NAT (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) of H19 was 0.70, the sensitivity was 100%, and the specificity was 50%. Conclusions: Plasma H19 expression level in patients with HER2 positive breast cancer is significantly higher compared with other subtypes. Plasma lncRNA H19 expression level is significantly decreased after NAT, and patients with more obvious decline are more likely to achieve pCR. Therefore, plasma H19 can be used as a potential predictor of NAT efficacy for different molecular subtypes.关键词：Breast cancer;Neoadjuvant therapy;Long non-coding RNA;LncRNA H19;Pathological complete response71|1194|0更新时间：2025-12-31
Article
- 摘要：Anaplastic lymphoma kinase (ALK) is one of the common oncogenic driver genes in non-small cell lung cancer (NSCLC). Tyrosine kinase inhibitors (TKIs) have achieved excellent therapeutic effects in patients with ALK fusion positive NSCLC. However, patients will eventually develop resistance to TKIs. Acquired molecular drug resistance mechanisms, such as ALK kinase domain mutation, ALK gene amplification and abnormal activation of bypass, are important drug resistance mechanisms affecting the effect of targeted therapy for ALK+ NSCLC. Acquired ALK kinase domain resistance mutations have become the focus of attention. With the deepening and popularization of next-generation sequencing (NGS), the drug resistance mutation spectrum of ALK TKI is becoming clearer, and acquired drug resistance may change dynamically. First, after the treatment failure of the first (G1)/second generation (G2) TKI, the secondary ALK kinase domain resistance mutation is mainly a single point mutation. About 20% of patients develop drug resistance mutations after failure of treatment with crizotinib, mainly L1196M, G1269A, C1156Y and F1174L. The incidence of point mutations following drug resistance to second-generation TKIs (including alectinib, ceritinib, brigatinib and ensartinib) is as high as 50%, and the types are more abundant, such as G1202R/del, F1174C/V and I1171T/N/S. In preclinical trials, compared with crizotinib, the G2 TKI has a higher inhibitory effect on ALK kinase and can cover most ALK resistance mutations, except G1202R/del. In addition to G1202R, F1174C/L and I1171N/S/T are the main drug-resistant mutations of ceritinib and alectinib respectively, and G1269A and E1210K are the main drug-resistant mutations of ensartinib. Secondly, the proportion of ALK double mutation and "off target" increase significantly following the resistance to the G2 TKIs. Following resistance to third generation (G3) TKI lorlatinib, almost all of them are compound mutations, and the degree of resistance is higher. I1171N double mutation and G1202R double mutation spectrum have been found. Among them, G1202R+L1196M double mutation shows high resistance to all ALK TKIs. In addition, after the progress of sequential multi-generation ALK TKI treatment, the original drug resistance sites change, the ratio of wild-type is increased, and the drug resistance mechanism may be more complex. At present, sequential G2/G3 TKIs can inhibit most drug-resistant mutations after crizotinib resistance. After the treatment progress of G2 TKI, the tumor inhibition effect can be achieved by sequential use of other G2 TKI or lorlatinib. For stubbern solvent frontier region mutation, lorlatinib has a significant inhibitory effect on G1202R mutation, while the lorlatinib resistant L1198F mutation and L1198F double mutation can be resensitized to crizotinib. Some compound mutations are sensitive to G2 TKIs, such as I1171N+L1196M and I1171N+G1269A mutations. Most compound drug-resistant mutations have not found effective inhibitors. The new generation TPX-0131 and NVL-655 show excellent antitumor effect in preclinical experiments, especially can overcome ALK compound drug resistance mutation, however, they still need to be verified by clinical trials. Identifying the kinase domain resistance mutation spectrum of ALK TKI and selecting sensitive and efficient TKIs treatment are the research hotspots in recent years. This paper focused on the mechanism of acquired ALK kinase domain resistance, and systematically summarized the relationship between ALK gene background and kinase domain resistance, ALK TKI kinase domain resistance mutation spectrum and treatment strategies. At the same time, repeated biopsy after tumor progression is very important for identifying ALK kinase domain mutations and selecting the most effective treatment strategy.关键词：Non-small cell lung cancer;Anaplastic lymphoma kinase;Kinase domain;Mutation;Drug resistance370|1635|0更新时间：2025-12-31
Review
- 摘要：Recently, new strategies for the integrated treatment of gynecological malignancies have been improved along with the development of reproductive oncology and hereditary tumors concepts. The traditional “single-disciplinary treatment” mode is difficult to optimally solve the diagnosis and treatment problems of patients. The application of multidisciplinary team (MDT) can provide the most scientific and reasonable diagnosis and treatment plan for patients and refine the existing therapies to improve the efficacy and quality of medical treatment. Based on the most recent advances and clinical practice experience in MDT of gynecological malignancies, The Society of Gynecological Cancer of China Anti-Cancer Association organized multidisciplinary experts in gynecologic oncology and related area to formulate “Consensus of Chinese experts on multidisciplinary team of gynecological malignant tumors (2022 edition)”, in order to improve the understanding of MDT among Chinese gynecologic oncologists and further standardize the application of MDT in gynecological malignancies.关键词：Gynecology;Tumor;Multidisciplinary team;Consensus811|3262|0更新时间：2025-12-31
Guideline and Consensus
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