早期乳腺癌局部治疗与全身治疗的进展与展望

李俊杰

doi:10.19401/j.cnki.1007-3639.2025.02.007

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早期乳腺癌局部治疗与全身治疗的进展与展望

专家述评 | 更新时间：2025-12-31

- 早期乳腺癌局部治疗与全身治疗的进展与展望
- Progress and future prospects in local and systemic treatment of early breast cancer
- 中国癌症杂志 2025年35卷第2期页码：205-212
- 作者机构：
  
  复旦大学附属肿瘤医院乳腺外科/复旦大学乳腺癌研究所，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "李俊杰，医学博士，副主任医师，副教授，硕士研究生导师。现担任复旦大学附属肿瘤医院乳腺外科行政副主任，浦东病区主任，科室教学秘书。2008年毕业于复旦大学临床医学七年制专业，后至美国麻省总院癌症中心乳腺癌临床专科进修学习。现主要从事乳腺癌的临床和基础研究，参与并设计多项国际、国内多中心临床试验，在Journal of Clinical Oncology等SCI收录期刊上发表论文近20篇。主持国家自然科学基金等项目，入选复旦大学青年临床科学家培养计划。现担任中国抗癌协会乳腺癌专业委员会青年专家、中华医学会乳腺肿瘤学组青年专家、上海市抗癌协会乳腺癌专业委员会常务委员及秘书长、中国抗癌协会国际医疗交流委员会常务委员、中国抗癌协会乳腺肿瘤整合康复委员会常务委员、北京癌症防治学会乳腺青委副主任委员等。" ]
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2025.02.007
  中图分类号： R737.9
- 收稿：2025-01-05，
  
  修回：2025-01-27，
  
  纸质出版：2025-02-28
- 稿件说明：
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李俊杰. 早期乳腺癌局部治疗与全身治疗的进展与展望[J]. 中国癌症杂志, 2025,35(2):205-212.

Junjie LI. Progress and future prospects in local and systemic treatment of early breast cancer[J]. China Oncology, 2025, 35(2): 205-212.
李俊杰. 早期乳腺癌局部治疗与全身治疗的进展与展望[J]. 中国癌症杂志, 2025,35(2):205-212. DOI： 10.19401/j.cnki.1007-3639.2025.02.007.

Junjie LI. Progress and future prospects in local and systemic treatment of early breast cancer[J]. China Oncology, 2025, 35(2): 205-212. DOI： 10.19401/j.cnki.1007-3639.2025.02.007.

摘要

乳腺癌是女性最常见的恶性肿瘤。早期乳腺癌指病灶局限在乳房和区域淋巴结，并无远处转移的乳腺癌，其治疗策略包括术前新辅助治疗、局部治疗[手术和（或）放疗

]

以及术后辅助治疗。早期乳腺癌具有高度异质性，因此需要根据不同的分子亚型以及临床病理学特征制定对应治疗策略。目前将乳腺癌根据雌激素受体、孕激素受体和人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）的表达，进一步划分为激素受体阳性型、三阴性乳腺癌（triple-negative breast cancer，TNBC）、HER2阳性型等亚型，伴随着不同分子分型的生物学特性的深入探索，一系列新药的推陈出新，譬如针对激素受体阳性型的CDK4/6抑制剂、针对HER2阳性的抗HER2靶向

治疗药物、针对TNBC的免疫治疗药物、针对

BRCA

突变的多腺苷二磷酸核糖聚合酶[poly (ADP-ribose) polymerase，PARP

]

抑制剂及新一代的抗体药物偶联物（antibody-drug conjugates，ADC）相继进入临床实践。结合精确的个体化治疗策略的实施，目前早期乳腺癌的预后不断提升，局部治疗也从“最大可耐受”模式更新至“最小最有效”模式。曾经绝大多数乳腺癌患者接受了全乳切除联合腋窝淋巴结清扫手术，而目前保乳手术和前哨淋巴结活检术已成为早期乳腺癌标准的手术方式。近20年来新辅助治疗促使肿瘤降期，更是为原本不可保乳、不可保腋窝的患者提供了外科降阶梯的可能。近年来，如何缩小手术范围，在保障治疗效果的同时减轻患者的身体、心理及经济负担的降阶梯局部治疗理念也不断普及。本文就早期乳腺癌局部和系统性治疗的现状、研究进展及展望予以综述，旨在为广大临床工作者提供参考。

Abstract

Breast cancer is the most common malignant tumor in women. Early breast cancer refers to primary lesion localized in the breast and regional lymph nodes

and without distant metastasis. Treatment strategies include preoperative neoadjuvant therapy

local treatment (surgery and/or radiotherapy)

and postoperative adjuvant therapy. Early breast cancer is highly heterogeneous

hence currently treatment strategies need to be formulated according to different molecular subtypes and pathology stages. At present

breast cancer is further divided into hormone receptor positive

triple negative breast cancer (TNBC)

human epidermal growth factor receptor 2 (HER2) positive and other undefined subtypes. With the in-depth exploration of the biological characteristics of different molecular types

a series of new drugs have been developed

such as CDK4/6 inhibitors for hormone receptor positive

anti HER2 targeted therapy for HER2 positive

immunotherapy for TNBC

poly (ADP-ribose) polymerase (PARP) inhibitors for

BRCA

mutations

and new generation of antibody-drug conjugates (ADCs) drug have entered clinical practice. Combined with the implementation of precision individualized treatment strategy

the prognosis of early breast cancer is also constantly improving

and local treatment is also updated from the "most tolerable" mode to the "least effective" mode

also known as “less is more”. Breast conserving surgery and sentinel lymph node biopsy have become the standard surgical methods for early breast cancer. The

neo-adjuvant treatment has promoted the tumor down-staging

and it has also provided the possibility of surgical step-down for patients who could not have breast conserving surgery or sentinel lymph node biopsy. In recent years

the concept of reducing the scope and trauma of surgery

ensuring treatment effectiveness while reducing the physical

psychological

and economic burden on patients through local treatment

has been increasingly popular. This article reviewed the updated research progress and future prospects of local and systematic treatment of early breast cancer aimed to provide reference for clinical workers.

关键词

Keywords

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