Tasoulis Marios-Konstantinos, Heil Joerg, Kuerer Henry M
Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK.
Division of Breast Cancer Research, The Institute of Cancer Research, Old Brompton Road, London, SW7 3RP UK.
Curr Breast Cancer Rep. 2022;14(4):135-141. doi: 10.1007/s12609-022-00453-3. Epub 2022 Jul 27.
De-escalation of surgery has been central in the evolution of multidisciplinary management of breast cancer. Advances in oncology and increasing use of neoadjuvant chemotherapy (NACT) have opened opportunities for further surgical de-escalation especially for HER2 + and triple negative (TN) disease. The aim of this review is to discuss the recent data on de-escalation of surgery as well as the future directions.
Patients with TN and HER2 + breast cancer with excellent response to NACT would be the ideal candidates for surgical de-escalation. Post-NACT image-guided biopsy, potentially combined with machine learning algorithms, may accurately identify patients achieving pathologic complete response that would be eligible for clinical trials assessing safety of omission of breast and axillary surgery.
Multidisciplinary research is required to further support results of preliminary studies. Current data point towards a future when even less or no surgery may be required for exceptional responders.
手术降级一直是乳腺癌多学科管理发展的核心。肿瘤学的进展以及新辅助化疗（NACT）的日益广泛应用为进一步的手术降级创造了机会，尤其是对于HER2阳性和三阴性（TN）疾病。本综述的目的是讨论手术降级的最新数据以及未来方向。
对NACT反应良好的TN和HER2阳性乳腺癌患者将是手术降级的理想候选者。NACT后的影像引导活检，可能结合机器学习算法，可以准确识别达到病理完全缓解的患者，这些患者有资格参加评估省略乳房和腋窝手术安全性的临床试验。
需要多学科研究来进一步支持初步研究的结果。目前的数据表明，未来对于反应特别好的患者可能需要更少甚至不需要手术。
