Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Japan.
Department of Breast Oncology, Gunma Prefectural Cancer Center, Ohta, Japan.
Jpn J Clin Oncol. 2020 Jun 10;50(6):629-634. doi: 10.1093/jjco/hyaa055.
Breast cancer is highly sensitive to systemic therapy. High probability of pathological complete response suggests a clinical question that omitting surgery is an effective alternative to surgery in breast cancer showing clinical complete response to primary systemic therapy. However, the validity of omitting surgery for early breast cancer after primary systemic therapy has not been sufficiently established; thus, even if pathological complete response is expected in patients showing clinical complete response, excision of the primary tumor site remains the standard treatment of breast cancer. Inappropriate omitting surgery increases the incidence of local recurrence, which can be the risk of a subsequent distant metastasis and reduced overall survival. To achieve acceptable local control rate, omitting surgery should be investigated in patients with early breast cancer where a high percentage of pathological complete response, a high concordance rate between clinical complete response and pathological complete response and an acceptable local control rate are expected. This review presents concept and ongoing clinical trials for omitting surgery for patients with breast cancer showing clinical complete response to primary systemic therapy.
乳腺癌对全身治疗高度敏感。高概率的病理完全缓解提示了一个临床问题，即在原发性全身治疗显示临床完全缓解的乳腺癌中，省略手术是手术的有效替代方法。然而，原发性全身治疗后省略手术治疗早期乳腺癌的有效性尚未得到充分证实；因此，即使预计患者会出现病理完全缓解，仍应切除原发性肿瘤部位，这仍然是乳腺癌的标准治疗方法。手术切除不适当会增加局部复发的发生率，这可能是随后远处转移和降低总体生存率的风险。为了实现可接受的局部控制率，应在预计具有高病理完全缓解率、临床完全缓解与病理完全缓解之间具有高一致性率以及可接受的局部控制率的早期乳腺癌患者中，对省略手术进行研究。本文综述了对原发性全身治疗显示临床完全缓解的乳腺癌患者省略手术的概念和正在进行的临床试验。
