Sin Tat-Hang, Huang Junying, Nie Longzhu, Mao Feng, Shen Songjie, Li Yan, Sun Qiang, Lu Junliang, Zhang Xiaohui, Zhou Yidong
Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Gland Surg. 2024 Jun 30;13(6):1126-1136. doi: 10.21037/gs-24-92. Epub 2024 Jun 27.
Breast cancer has become a critical international healthcare issue. Specifically, among the different subtypes, breast cancer marked by human epidermal growth factor receptor 2 (HER2)-overexpression usually correlates with low survival and a poor prognosis and poses challenges in treatment, thus leading to high mortality.
A 54-year-old female patient was diagnosed with a large T4cN2aM0 stage IIIB breast tumor with HER2 overexpression. The tumor size was large, and there was a lack of opportunity for surgery. However, after neoadjuvant chemotherapy (NACT), the size of the tumor continuously shrank, and the patient successfully underwent a modified radical mastectomy. Even though a certain amount of mass remained and she did not complete six courses of NACT, our patient's postoperative pathological result still revealed that a pathological complete response (pCR) was achieved. The appropriate time window for choosing surgical intervention should be determined based on the patient's general condition instead of complying with the treatment guidelines. Also, imaging findings may be misleading in patients who have undergone NACT. Moreover, the regimen should be chosen flexibly.
Patients with locally advanced breast cancer can still achieve a radical surgical resection following appropriate comprehensive treatment. Hopefully, this case can provide new ideas for surgeons when they face similar conditions.
乳腺癌已成为一个关键的国际医疗保健问题。具体而言,在不同亚型中,以人表皮生长因子受体2(HER2)过表达为特征的乳腺癌通常与低生存率和不良预后相关,并且在治疗方面带来挑战,从而导致高死亡率。
一名54岁女性患者被诊断为患有伴有HER2过表达的T4cN2aM0 IIIB期大乳腺癌肿瘤。肿瘤体积较大,且缺乏手术机会。然而,新辅助化疗(NACT)后,肿瘤体积持续缩小,患者成功接受了改良根治性乳房切除术。尽管仍有一定量的肿块残留且患者未完成六个疗程的NACT,但患者的术后病理结果仍显示达到了病理完全缓解(pCR)。选择手术干预的合适时间窗应基于患者的一般状况来确定,而非遵循治疗指南。此外,对于接受过NACT的患者,影像学检查结果可能会产生误导。而且,治疗方案应灵活选择。
局部晚期乳腺癌患者在经过适当的综合治疗后仍可实现根治性手术切除。希望该病例能为外科医生面对类似情况时提供新思路。