Yu H Hy, Cheung P Sy, Leung R Cy, Leung T N, Kwan W H
Department of Surgery, Ruttonjee & Tang Shiu Kin Hospitals, Wanchai, Hong Kong.
Breast Care Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong.
Hong Kong Med J. 2017 Aug;23(4):387-94. doi: 10.12809/hkmj166049. Epub 2017 Jun 26.
Pregnancy-associated breast cancer is the most common malignancy during pregnancy with an expected rise in incidence. The belief in the need for termination of pregnancy and that chemotherapy is contra-indicated during pregnancy is challenged by recent evidence. Patients can consider breast-conserving surgery and sentinel lymph node biopsy with acceptably low fetal risk from radiation exposure. A range of chemotherapeutics is possible in the second trimester in terms of drug class and frequency. Hormonal therapy and monoclonal antibody therapy are contra-indicated during pregnancy and lactation. Fetal outcome after in-utero exposure to chemotherapy appears similar to that in a non-pregnant population. Future pregnancy, in most situations, does not appear to be contra-indicated but a multidisciplinary and patient-centred approach is recommended. Fertility preservation techniques are also being developed with reported success and consequent pregnancies.
妊娠相关乳腺癌是孕期最常见的恶性肿瘤，其发病率预计会上升。近期证据对终止妊娠的必要性以及孕期化疗禁忌的观念提出了挑战。患者可考虑保乳手术和前哨淋巴结活检，辐射暴露对胎儿的风险可接受且较低。孕中期在药物种类和用药频率方面有多种化疗药物可供选择。孕期和哺乳期禁忌使用激素疗法和单克隆抗体疗法。宫内接触化疗后的胎儿结局似乎与非孕人群相似。在大多数情况下，未来怀孕似乎并非禁忌，但建议采用多学科且以患者为中心的方法。生育力保存技术也在不断发展，已有成功案例及后续妊娠的报道。
