Wang J, Xiu B Q, Guo R, Yang B L, Zhang Q, Su Y H, Li L, Ji W R, Zhang Y Y, Cao A Y, Shao Z M, Wu J
Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Zhonghua Zhong Liu Za Zhi. 2020 Nov 23;42(11):931-936. doi: 10.3760/cma.j.cn112152-20190924-00623.
To investigate the current trend of breast cancer neoadjuvant therapy and provide reference for the improvement of breast cancer clinical guideline in the future. Questionnaires of cross-sectional survey were sent to 110 hospitals (breast cancer surgery quantity surpassing 200) between July 2018 and September 2018. The stages and subtypes, therapeutic regimen, treatment assession, operation choice and preforming of patients underwent neoadjuvant therapy were recorded. Neoadjuvant treatment has been performed in all of the 110 hospitals. The total number of breast patients underwent neoadjuvant therapy was about 14 550 (17.0% in surgical patients) in 2017. For all of the neoadjuvant patients, the proportion of stageⅡ patients was less than 30% in 81 hospitals, and the proportion of stage Ⅲ was more than 50% in 84 hospitals. The numbers of estrogen receptor (ER) (+ )/human epidermal growth factor receptor-2 (HER-2) (-), ER (-)/HER-2 (+ ) and triple negative subtype breast cancer patients were 3 550 (24.4%), 6 024 (41.4%) and 4 991 (34.3%), respectively. Patient's scruples of relatively delayed operation and weak will of breast conservation after neoadjuvant therapy were the majority reasons for neoadjuvant therapy restriction. Anthracycline followed by taxane was the most usual neoadjuvant therapeutic regimens in 53.6% hospitals, and anthracycline plus taxane was the first choice in 42.7% hospitals. Chemotherapy with targeting therapy was recommended to HER-2 positive neoadjuvant patients in 80.9% hospitals. To assess treatment outcome of neoadjuvant treatment, 42.7% hospitals used MRI in more than 50% patients while the usage rate of MRI was less than 20% in 37.3% hospitals. The proportions of hospital using repeat-marking, tattoo and metal clip as the first method to identify the primary tumor region and lymph nodes were 60.0%, 29.1% and 10.9%, respectively. Breast-conservation rate after neoadjuvant therapy was less than 20% in 87.3% hospitals. Neoadjuvant therapy for breast cancer is widely performed in most hospitals in China, while the proportion of neoadjuvant treatment in patients with operable breast cancer is still low. Meanwhile, the idea of achieving de-escalation operation through neoadjuvant treatment is not promoted and the therapeutic evaluation method of neoadjuvant treatment needs further studies to improve.
探讨乳腺癌新辅助治疗的现状趋势，为未来完善乳腺癌临床诊疗规范提供参考。于2018年7月至9月向110家（乳腺癌手术量超过200例）医院发放横断面调查问卷。记录接受新辅助治疗患者的分期及亚型、治疗方案、疗效评估、手术选择及实施情况。110家医院均开展了新辅助治疗。2017年接受新辅助治疗的乳腺癌患者总数约14550例（占手术患者的17.0%）。在所有新辅助治疗患者中，81家医院Ⅱ期患者比例不足30%，84家医院Ⅲ期患者比例超过50%。雌激素受体（ER）（+）/人表皮生长因子受体-2（HER-2）（-）、ER（-）/HER-2（+）及三阴性亚型乳腺癌患者例数分别为3550例（24.4%）、6024例（41.4%）和4991例（34.3%）。新辅助治疗后患者对手术相对延迟的顾虑及保乳意愿不强是限制新辅助治疗的主要原因。53.6%的医院最常用的新辅助治疗方案是蒽环类序贯紫杉类，42.7%的医院首选蒽环类联合紫杉类。80.9%的医院对HER-2阳性新辅助治疗患者推荐化疗联合靶向治疗。为评估新辅助治疗效果，42.7%的医院在超过50%的患者中使用磁共振成像（MRI），37.3%的医院MRI使用率低于20%。采用重复标记、纹身及金属夹作为识别原发肿瘤区域及淋巴结首选方法的医院比例分别为60.0%、29.1%和10.9%。87.3%的医院新辅助治疗后的保乳率低于20%。我国多数医院广泛开展乳腺癌新辅助治疗，但可手术乳腺癌患者新辅助治疗比例仍较低。同时，通过新辅助治疗实现降阶梯手术的理念未得到推广，新辅助治疗的疗效评估方法有待进一步研究改进。
