CR-UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Edgbaston B15 2TT, UK.
Eur J Surg Oncol. 2013 Sep;39(9):924-30. doi: 10.1016/j.ejso.2013.06.005. Epub 2013 Jul 8.
Surgery is an obligatory component of treatment for early breast cancer. The last 20 years developments in systemic neoadjuvant therapy have progressively increased pathological complete response (pCR). Pathological complete response is associated with excellent prognosis especially for hormone receptor negative cancers. Therapeutic advances and recognition of the importance of pathological subtype in predicting pCR facilitate identification of subgroups with very high pCR rates. Treatment of HER2 positive hormone receptor negative cancers with combination chemotherapy and multiple targeted anti-HER2 agents results in consistently high pCR rates of 60-83%. Routine surgery in this setting where most patients have no potential to benefit is of questionable value and the option of omitting surgery in these patients should now be explored in a randomized trial. For HER2 positive disease not achieving pCR after neoadjuvant treatment the outcomes are poor. Trials are underway to determine if outcomes for these patients can be improved with alternative targeted therapy.
手术是早期乳腺癌治疗的强制性组成部分。过去 20 年，系统新辅助治疗的发展逐渐提高了病理完全缓解（pCR）率。病理完全缓解与良好的预后相关，尤其是对于激素受体阴性的癌症。治疗进展和对病理亚型在预测 pCR 中的重要性的认识，有助于确定具有非常高 pCR 率的亚组。曲妥珠单抗联合化疗和多种靶向抗 HER2 药物治疗 HER2 阳性激素受体阴性癌症，可使 pCR 率稳定达到 60-83%。在这种情况下，大多数患者没有获益的潜力，因此常规手术的价值值得怀疑，现在应该在随机试验中探讨在这些患者中省略手术的可能性。对于新辅助治疗后未达到 pCR 的 HER2 阳性疾病，结局较差。目前正在进行临床试验，以确定对于这些患者，是否可以通过替代靶向治疗来改善结局。
