Gao Wei, Wang Jiaxing, Yin Sifei, Geng Cuizhi, Xu Binghe
Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China.
Department of Chemical and Systems Biology, Stanford University, Stanford, California 94305 USA.
Holist Integr Oncol. 2022;1(1):8. doi: 10.1007/s44178-022-00010-z. Epub 2022 Jul 5.
Major public health emergencies may lead to delays or alterations in the treatment of patients with breast cancer at each stage of diagnosis and treatment. How much do these delays and treatment changes affect treatment outcomes in patients with breast cancer?
This review summarized relevant research in the past three decades and identified the effect of delayed treatment on the prognosis of patients with breast cancer in terms of seeking medical treatment, neoadjuvant treatment, surgery, postoperative chemotherapy, radiotherapy, and targeted therapies.
Delay in seeking medical help for ≥12 weeks affected the prognosis. Surgical treatment within 4 weeks of diagnosis did not affect patient prognosis. Starting neoadjuvant chemotherapy within 8 weeks after diagnosis, receiving surgical treatment at 8 weeks or less after the completion of neoadjuvant chemotherapy, and receiving radiotherapy 8 weeks after surgery did not affect patient prognosis. Delayed chemotherapy did not increase the risk of relapse in patients with luminal A breast cancer. Every 4 weeks of delay in the start of postoperative chemotherapy in patients with luminal B, triple-negative, or HER2-positive breast cancer treated with trastuzumab will adversely affect the prognosis. Targeted treatment delays in patients with HER2-positive breast cancer should not exceed 60 days after surgery or 4 months after diagnosis. Radiotherapy within 8 weeks after surgery did not increase the risk of recurrence in patients with early breast cancer who were not undergoing adjuvant chemotherapy.
Different treatments have different time sensitivities, and the careful evaluation and management of these delays will be helpful in minimizing the negative effects on patients.
重大突发公共卫生事件可能导致乳腺癌患者在诊断和治疗的各个阶段出现治疗延迟或改变。这些延迟和治疗变化对乳腺癌患者的治疗结果有多大影响？
本综述总结了过去三十年的相关研究，从就医、新辅助治疗、手术、术后化疗、放疗和靶向治疗等方面确定了延迟治疗对乳腺癌患者预后的影响。
就医延迟≥12周会影响预后。诊断后4周内进行手术治疗不影响患者预后。诊断后8周内开始新辅助化疗、新辅助化疗完成后8周或更短时间内接受手术治疗以及术后8周接受放疗均不影响患者预后。延迟化疗不会增加腔面A型乳腺癌患者的复发风险。接受曲妥珠单抗治疗的腔面B型、三阴性或HER2阳性乳腺癌患者，术后化疗开始每延迟4周都会对预后产生不利影响。HER2阳性乳腺癌患者的靶向治疗延迟不应超过术后60天或诊断后4个月。术后8周内进行放疗不会增加未接受辅助化疗的早期乳腺癌患者的复发风险。
不同治疗具有不同的时间敏感性，对这些延迟进行仔细评估和管理将有助于将对患者的负面影响降至最低。
