中国乳腺癌随诊随访与健康管理指南(2022版)

近年来,随着对乳腺癌筛查的重视与规范化诊疗技术的提升,中国乳腺癌患者治愈率显著提高,患者生存时间显著延长。伴随乳腺癌患者随诊随访期的延长,患者面临的肿瘤及相关其他健康问题也逐渐增加,需要制定更为精准而长远的随诊随访计划,关注更广泛的健康风险。抗肿瘤治疗、年龄、激素水平变化等因素导致的乳腺癌患者心血管、骨健康、心理健康等问题,已成为乳腺癌患者管理的新难题,其不仅影响患者的生活质量,甚至转化为疾病复发和死亡风险。因此,除了落实规范化治疗外,患者科学规范的随诊随访、伴随疾病的全方位管理、跨学科协作、全面康复也是乳腺癌治疗的关键环节,这对于提高患者的治疗效果,提升患者健康水平和生活质量均有重大意义。基于当前中国乳腺癌患者的治疗及随诊随访现状,根据文献及指南,结合跨学科专家诊疗建议,在2019版《乳腺癌随访及伴随疾病全方位管理指南》基础上进行更新,修订2022版《中国乳腺癌随诊随访与健康管理指南》,包括随诊随访路径图、随诊随访管理、全方位健康管理以及患者报告结局四大部分,旨在规范乳腺癌患者的长期随诊随访,指导临床医师积极开展乳腺癌患者全方位跨学科健康管理,从而进一步提高中国乳腺癌患者预后与生活质量。     

14例妊娠期乳腺癌的诊疗体会及文献回顾

目的探讨妊娠期乳腺癌综合治疗的方法及特点。方法回顾性分析14例妊娠期乳腺癌患者的临床资料,探讨临床综合治疗的特点和体会并文献分析。结果 14例妊娠期乳腺癌患者中Ⅱ期6例,Ⅲ期7例,Ⅳ期1例;随访结果显示3例患者死亡,3例患者失访,8例患者无病生存。结论妊娠期乳腺癌恶性程度较高,预后较差,除胎儿因素外,其治疗原则与非妊娠期乳腺癌相同;在治疗中需要综合考虑胎儿安全及患者因素,根据具体情况制定合适的诊疗方案。     

乳腺癌患者术中保留肋间臂神经的临床意义

随着乳腺癌患者对生活质量要求的提高,在乳腺癌手术中保留肋间臂神经（intercostobrachial nerve,ICBN）正逐渐被广泛应用。我们通过分析220例乳腺癌患者的临床、随访资料,探讨了保留ICBN手术治疗乳腺癌患者的临床疗效。     

乳腺癌综合治疗后随访策略探讨

[目的]探讨乳腺癌综合治疗后合理的随访间隔时间、必需的检查项目及有效的随访方式。[方法]对140例乳腺癌综合治疗后患者行每3个月1次随访,共2年,记录每次随访方式及结果。探讨年龄、职业、手术方式、病期等因素与随访率的关系。[结果]患者年龄、手术方式、内分泌治疗情况与随访率无显著相关性。教育程度、职业、临床分期与随访率有显著相关性(P<0.05)。[结论]应宣教让患者理解随访的重要性,提高随访率,并选择合理检查项目及时间间隔。     

应用个案管理模式提高乳腺癌患者复查随访率

目的评价个案管理模式在提高乳腺癌患者复查随访率方面的作用。方法回顾分析本院乳腺疾病诊疗中心2008年8月至2010年4月病理确诊为乳腺癌患者273例病例资料,其中施行个案管理模式前132例（A组）,施行个案管理模式后141例（B组）。患者完成手术和／或化学药物治疗及放射治疗等临床治疗,医嘱患者3个月后返院复查。比较个案管理模式管理前、后患者的首次复查随访率。统计分析采用卡方检验和秩和检验。结果A组患者的首次复查随访率为78．79％（104／132）,B组的首次复查随访率为91．49％（129／141）,较A组提高了12．70％（P=0．003）。结论应用个案管理模式能够提高乳腺癌患者的有效复查随访率,便于早期发现复发转移倾向,抓住最佳治疗时机,采取相应的治疗和护理措施。     

双侧原发性乳腺癌267例临床分析

目的探讨双侧原发性乳腺癌（bilateral primary breast cancer, BPBC）的临床病理特征及治疗和预后。方法回顾性分析267例双侧原发性乳腺癌患者的临床资料。结果第一侧为浸润性小叶癌为双侧乳腺癌发病的危险因素。双侧原发性乳腺癌占同期手术治疗乳腺癌的约4％,同时性双侧乳腺癌占18％,异时性双侧乳腺癌占82％。双侧原发性乳腺癌的治疗均应遵循普通乳腺癌的治疗原则。异时性双乳癌的总生存率（OS）高于同时性双乳癌。结论单侧乳腺癌患者,对侧乳腺癌发生的危险度逐年增加,应建立完善的随访制度,做到早期发现,早期诊断及早期治疗第二癌,提高双侧乳腺癌患者的治愈率及生存率。     

血清HER-2单独及联合检测在乳腺癌随访中的意义

目的:乳腺癌的随访常以CA15-3及CEA等作为监测肿瘤进展的指标,但其敏感性仍不能满足临床需要.而组织中HER-2(human epidermal growth factor receptor,人表皮生长因子受体-2)基因的过表达已被证实与乳腺癌患者预后较差相关.本研究目的即初步确立乳腺癌患者治疗后随访单独或者联合检测的指标.方法:应用酶联免疫技术(ELISA法)对44例乳腺癌患者进行治疗前后血清HER-2水平的测定,并取同步血清样本行肿瘤标志物CEA、CA15-3及血清VEGF、b-FGF、EGF的检测.对所有患者进行每半年的随访直至病情进展.结果:乳腺癌患者血清HER-2水平在治疗后明显下降(14.23ng/ml vs.6.39ng/ml),在出现复发转移的患者中明显升高(21.73ng/ml vs.5.36ng/ml).血清HER-2单独检测时特异性最高,达80.95%;联合检测血清HER-2及b-FGF的敏感性最高,达90.91%;联合检测血清HER-2及CA15-3的诊断准确性最高,达78.05%.随访结果显示,治疗后血清HER-2水平及CA15-3水平是影响乳腺癌患者的无进展生存的主要因素.结论:血清HER-2随着乳腺癌患者病情进展而升高,且便于检测,可独立或与CA15-3联合检测作为患者随访的指标.     

中国早期乳腺癌卵巢功能抑制临床应用专家共识（2024年版）

中国乳腺癌患者发病年龄较轻,60%的女性患者在诊断时为绝经前。与绝经后相比,未绝经女性卵巢功能旺盛,可持续大量分泌雌激素、促进乳腺癌细胞增殖。卵巢功能抑制（ovarian function suppression,OFS）已用于乳腺癌临床治疗数十年,大量循证证据表明,单用OFS和加用OFS均可降低未绝经女性乳腺癌的复发风险并改善生存。部分OFS研究的长期随访数据（SOFT/TEXT研究12和13年随访、STO-5研究20年随访、亚裔人群的ASTRRA研究8年随访）近期陆续公布,进一步证实对于早期乳腺癌患者加用OFS可显著降低10年以上的复发风险,提高治愈可能。monarchE和NATALEE研究显示,部分CDK4/6抑制剂叠加在绝经前早期乳腺癌患者含有药物去势[促性腺激素释放激素类似物（gonadotropin releasing hormone analog,GnRHa）]的辅助内分泌治疗方案时仍可进一步增加生存获益。中国抗癌协会乳腺癌专业委员会召集了国内乳腺癌治疗领域的临床专家,在2021年版的基础上共同商讨编制了《中国早期乳腺癌卵巢功能抑制临床应用专家共识（2024年版）》。本共...     

早期乳腺癌保乳手术近期疗效评价

目的 分析临床早期乳腺癌保乳综合治疗的近期疗效,为普及临床早期乳腺癌保乳综合治疗提供参考.方法 2002年9月至2006年1月对122例临床早期乳腺癌患者施行保乳手术,对肿瘤采取局部扩大切除或乳房象限切除,所有患者均行腋窝淋巴结清除;术后辅以放疗、化疗或内分泌治疗.结果 122例患者均获随访,随访时间8～49个月,无局部复发、远处转移和死亡病例.保乳治疗乳房美容效果评估优、良者占90.16%(110/122).结论 临床早期乳腺癌保乳综合治疗创伤小、美容效果良好、疗效满意,可显著提高患者生活质量,值得广泛推广应用,但必须严格掌握手术适应证.     

血清HER-2单独及联合检测在乳腺癌随访中的意义

目的：乳腺癌的随访常以CA15—3及CEA等作为监测肿瘤进展的指标,但其敏感性仍不能满足临床需要。而组织中HER-2（human epidermal growth factor receptor ,人表皮生长因子受体-2）基因的过表达已被证实与乳腺癌患者预后较差相关。本研究目的即初步确立乳腺癌患者治疗后随访单独或者联合检测的指标。方法：应用酶联免疫技术（ELISA法）对44例乳腺癌患者进行治疗前后血清HER-2水平的测定,并取同步血清样本行肿瘤标志物CEA、CAl5—3及血清VEGF、b—FGF、EGF的检测。对所有患者进行每半年的随访直至病情进展。结果：乳腺癌患者血清HER-2水平在治疗后明显下降（14．23ng／mlVS．6．39ng／ml）,在出现复发转移的患者中明显升高（21．73ng／mlvs．5．36ng／ml）。血清HER-2单独检测时特异性最高,达80．95％;联合检测血清HER-2及b—FGF的敏感性最高,达90．91％;联合检测血清HER-2及CA15—3的诊断准确性最高,达78．05％。随访结果显示,治疗后血清HER-2水平及CA15—3水平是影响乳腺癌患者的无进展生存的主要因素。结论：血清HER-2随着乳腺癌患者病情进展而升高,且便于检测,可独立或与CA15—3联合检测作为患者随访的指标。     

Long-term effects of adjuvant tamoxifen and/or radiotherapy. The South Sweden Breast Cancer Trial.

In a multicenter trial of adjuvant therapy in stage II breast cancer, 719 postmenopausal patients were randomized to one of three treatment regimens: radiotherapy only or in combination with adjuvant tamoxifen for one year, or adjuvant tamoxifen without radiotherapy. At twelve years of follow-up (median 9 years), no statistically significant differences in survival or recurrence-free survival were observed. However, the rate of loco-regional recurrency was lower among patients treated with both radiotherapy and tamoxifen. The rate of bilateral breast cancer was reduced in tamoxifen-treated patients whereas the rate of new primary malignancies other than breast cancer was somewhat higher in tamoxifen-treated patients. Adjuvant therapy in breast cancer may influence not only breast cancer recurrences and mortality but also later disease patterns and cause-specific mortality.     

Combined modality treatment of local regionally advanced breast cancer patients. 5 to 10 year follow-up

Local regionally advanced breast cancer carries a poor prognosis overall. There is little published information regarding the long-term follow-up of such patients prospectively treated with surgery, radiation therapy, and early systemic therapy. This communication reports 5-10 year follow-up results on 32 women with local regionally advanced breast cancer prospectively treated with initial surgery followed by systemic chemotherapy and irradiation therapy. Median relapse-free and overall survivals in these women were 37.6 and 62 months, respectively. Nine patients (28%) are currently alive and disease-free 5 to 10 years after diagnosis. Women with inflammatory breast cancer fared as well as other patients with local regionally advanced breast cancer in this small trial. None of 10 patients with gross disease after an initial mastectomy is disease-free as opposed to 9 of 22 women with initially resectable disease (41%). Thus, an appreciable minority of women with resectable local regionally advanced breast cancer may have prolonged disease-free survivals following combined modality therapy.     

Elderly breast cancer patients treated by conservative surgery alone plus adjuvant tamoxifen: fifteen-year results of a prospective study

BACKGROUND: In elderly patients with early breast cancer and a clinically clear axilla, axillary surgery, sentinel lymph node biopsy, and postoperative radiotherapy to the residual breast may not be necessary because of reduced life expectancy, effectiveness of hormone therapy in achieving long-term disease control, and generally favorable biologic behavior of breast cancer in elderly patients. METHODS: The authors followed 354 prospectively recruited women aged > or =70 years who had primary, operable breast cancer and no palpable axillary lymph nodes. All 354 women were treated with conservative surgery and adjuvant tamoxifen and without axillary dissection or postoperative radiotherapy. Women who had resection margins in tumor tissue were excluded. Endpoints were cumulative incidence of axillary disease, cumulative incidence of ipsilateral breast tumor recurrence (IBTR), and breast cancer mortality. RESULTS: After a median follow-up of 15 years (interquartile range, 14-17 years), the crude cumulative incidence was 4.2% (4% in pathologic T1 [pT1] tumors) for axillary disease, 8.3% (7.3% in pT1 tumors) for IBTR, and 17% for breast cancer mortality. Of the 268 patients who died during follow-up, 222 patients (83%) died from causes unrelated to breast cancer. CONCLUSIONS: Elderly patients with early breast cancer and no palpable axillary lymph nodes may be safely treated safety by conservative surgery without axillary dissection and without postoperative radiotherapy, provided that surgical margins are in tumor-free tissue and that hormone therapy is administered. Sentinel lymph node biopsy is also unnecessary because of the low cumulative incidence of axillary disease, and axillary surgery can be reserved for the small proportion of patients who later develop overt axillary disease.     

早期乳腺癌保乳手术34例临床分析

目的探讨早期乳腺癌保乳手术适应证、禁忌证、手术技巧、术后综合治疗及疗效。方法回顾性分析2005年1月～2011年1月收治的34例临床Ⅰ～Ⅱ期乳腺癌患者的临床资料。结果术后随访时间为6个月～6年,所有患者术后恢复良好,未见术后并发症、局部复发和远处转移病例,患者对术后乳房外形和生活质量较满意。结论早期乳腺癌可行保乳手术,术后辅助化疗、放疗和内分泌综合治疗,疗效确切,且可取得满意的美容效果。     

Contralateral primary tumors in breast cancer patients in a randomized trial of adjuvant tamoxifen therapy

Prophylactic treatment with the anti-estrogen tamoxifen may reduce the risk of breast cancer because estrogens are thought to act as promoters in the pathogenesis of the disease. This article presents results on the incidence of contralateral new primary tumors among 1846 postmenopausal breast cancer patients included in a randomized trial of adjuvant tamoxifen therapy for 2 or 5 years after surgery versus no adjuvant endocrine therapy. The median follow-up was 7 years (range, 3-13 years). There was a significant reduction of contralateral breast cancer in the 931 patients in the tamoxifen group versus that in the 915 control patients (29 versus 47 cases, respectively; P = .03). The cumulative incidence at 10 years in the tamoxifen group and the control group was 5% and 8%, respectively. Analysis of the relative hazard of contralateral tumor over time showed that the benefit with tamoxifen therapy was greatest during the first 1-2 years, but there was a continued risk reduction during the entire follow-up period, i.e., more than 10 years after cessation of treatment. There was no significant difference in the number of contralateral cancers in the patients randomly assigned to 2 or 5 years of treatment, but the 95% confidence interval of the relative hazard was wide. The proportion of estrogen receptor-negative contralateral breast cancers was higher in the tamoxifen group than in the control group. There was no difference, however, between the two groups in recurrence-free survival time from the diagnosis of the contralateral cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Emerging data on optimal adjuvant endocrine therapy: Breast International Group trial 1-98/MA.17

In recent years, several major trials have studied aromatase inhibitors (AIs)/inactivators as adjuvant therapy for postmenopausal women with early-stage breast cancer. The AIs have demonstrated improved efficacy compared with 5 years of tamoxifen when used as initial therapy or when used sequentially after 2-3 years. They also improve outcomes when used after 5 years of adjuvant tamoxifen in this patient population. In all cases, AIs improve disease-free survival compared with the standard 5 years of adjuvant tamoxifen, leading to a reassessment of the optimal adjuvant endocrine therapy for postmenopausal patients with breast cancer. The American Society of Clinical Oncology now recommends the inclusion of an AI into the adjuvant regimen at some point for most postmenopausal patients with hormone receptor-positive early-stage breast cancer. However, the optimal duration of AI therapy and the comparative efficacy and safety of the alternative strategies for their incorporation remain matters of debate. In addition, the long-term impact of AIs on other organs, such as the bone and cardiovascular systems, is not completely understood, and longer follow-up of patients from these original trials as well as carefully planned future trials with appropriate substudies are essential to determine the optimal endocrine treatment strategy.     

Caring for the Whole Patient After Breast Cancer Therapy: A Survivorship Guide for Radiation Oncologists

With 5-year survival rates after breast cancer therapy exceeding 90%, comprehensive follow-up care is a vital component of the treatment plan for patients who have completed active therapy. Although radiation oncologists are generally comfortable with management of the locoregional toxicities of breast cancer radiation therapy, many may be less familiar with the toxicities and available interventions associated with surgery, chemotherapy, and antihormone therapy. For radiation oncologists to provide the greatest value to their patients and play a meaningful role in patients with breast cancer follow-up care, multisystem assessment and management, beyond the breast/chest and axilla, is key.This guide is intended as an educational and practical tool to assist any oncology caregiver with a thorough multisystem assessment and management of the most common survivorship issues for the treated breast cancer patient. Hyperlinks to published data supporting or summarizing the intervention are provided for further reading in the online version, along with sample “Follow-Up Note and After Visit Summary” templates.     

早期乳腺癌手术术式选择

目的 探讨早期乳腺癌外科手术术式的选择,以及我国开展保乳治疗的可行性.方法 回顾分析1999年6月1日-2000年6月1日74例早期乳腺癌的病历资料,其中传统根治术25例,改良根治术34例,保乳手术15例.结果 随诊5年,74例早期乳腺癌患者无局部复发病例,2例于4年后出现远处转移,余72例均获得无瘤生存,三组间差异无统计学意义(P＞0.05).结论 随着早期乳腺癌检出率的提高以及对乳腺癌生物学认识上的飞跃,治疗的策略发生了巨变,外科手术切除范围趋向于缩小,改良根治术目前已成为早期乳腺癌主要的外科治疗方法之一,保留乳房的保守性手术在中国是可行的,也将是早期乳腺癌患者优先选择的手术方式.     

Adjuvant treatment in elderly patients with breast cancer: critical review of clinical practice

Today the use of adjuvant treatment of breast cancer is unquestionable in the management of this disease. Both chemotherapy and hormonal therapy have proved to be beneficial, not only with respect to the reduction of the risk of recurrence, but also with respect to mortality. However, in elderly patients, this therapeutic approach is occasionally the subject of controversy, due to the undervaluing of the tumoral disease with respect to the multiple pathology frequently present in these patients. This study analyses a retrospective series of 100 patients more than 70 years old with breast cancer who underwent radical surgery between 1990 and 1998, with an extension study without evidence of metastasis and a minimum follow-up of 2 years. As occurs in the population of this age, in our series 77% of the patients presented with concomitant disease under medical treatment, and although the majority received adjuvant treatment with tamoxifen, the principal cause of death in this series was the breast cancer that had been diagnosed.     

Breast conservation treatment for patients presenting with axillary lymphadenopathy from presumed primary breast cancer: the role of breast magnetic resonance imaging for staging

Three female patients presented with malignant axillary lymphadenopathy presumed to be from primary breast cancer. No evidence of primary cancer was found in the breast on either mammography or breast magnetic resonance imaging (MRI). All 3 patients underwent axillary lymph node dissection and systemic chemotherapy followed by radiation therapy to the breast and regional lymph nodes. Two patients remain relapse free with a follow-up of 3.7 years each. The third patient achieved locoregional control in the ipsilateral breast and regional lymph nodes but relapsed in the contralateral axilla. These 3 cases illustrate the potential for breast conservation treatment for patients presenting with axillary adenopathy from a presumed primary breast cancer but without either mammographic or breast MRI findings.