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近年来，乳腺癌已经超越肺癌，成为全世界最常见的癌症。不过，由于乳腺癌的分子生物学特征已被广泛分析，故人们对乳腺癌的看法发生了巨大变化。 2021年4月1日，国际四大医学期刊之一、英国《柳叶刀》正刊发表德国乳腺癌协作组、法兰克福贝哈尼亚癌症中心、马尔堡大学医院、比利时安特卫普大学肿瘤医院、美国纽约纪念医院斯隆凯特林癌症中心、意大利米兰大学欧洲肿瘤研究院的长篇综述，对近年来全球发表的225篇乳腺癌重要文献进行了系统回顾，其中包括复旦大学附属肿瘤医院余科达、叶富贵、贺敏、范蕾、马丁、莫淼、吴炅、柳光宇、狄根红、侯意枫、沈镇宙、邵志敏等学者发表于《美国医学会杂志》肿瘤学分册的中国三阴性乳腺癌术后辅助化疗新白金方案PATTERN研究。本文长达20页，重点围绕以下内容： 新的分子生物学标志组合，包括免疫组织化学标志（例如雌激素受体、孕激素受体、ERBB2基因编码的HER2、MKI67基因编码的增殖标志蛋白Ki-67）、基因组标志（例如BRCA1、BRCA2、PIK3CA）、免疫标志（例如肿瘤浸润淋巴细胞、程序性死亡蛋白PD-1、程序性死亡蛋白配体PD-L1），为日益复杂的诊断方法奠定了基础。 早期乳腺癌术前新辅助联合治疗已经成为治疗标准，其中通常包括靶向药物，尤其对于HER2阳性乳腺癌和三阴性乳腺癌，并且成为乳房和腋窝手术简化以及根据风险制定新辅助治疗后策略的基础。 放疗仍然是乳腺癌治疗的重要基石，但是短疗程大分割简化方案已经成为治疗标准。 根据个体风险评定，可对雌激素受体阳性乳腺癌进行5～10年的内分泌治疗和化疗。 对于晚期乳腺癌，根据肿瘤类型和分子特征，标准治疗可选靶向治疗，例如CDK4和CDK6抑制剂、PI3K抑制剂、PARP抑制剂、PD-1或PD-L1抑制剂等免疫治疗。 上述治疗选择范围反映了当今乳腺癌治疗的复杂性。 Lancet. 2021 Apr 1. Online ahead of print. Breast Cancer. Sibylle Loibl, Philip Poortmans, Monica Morrow, Carsten Denkert, Giuseppe Curigliano. German Breast Group, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany; Philipps University of Marburg, Marburg, Germany; University Hospital Marburg, Marburg, Germany; Iridium Kankernetwerk, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium; Memorial Sloan Kettering Cancer Center, New York, NY, USA; European Institute of Oncology IRCCS, Milan, Italy; University of Milano, Milan, Italy. Breast cancer is still the most common cancer worldwide. But the way breast cancer is viewed has changed drastically since its molecular hallmarks were extensively characterised, now including immunohistochemical markers (eg, ER, PR, HER2 [ERBB2], and proliferation marker protein Ki-67 [MKI67]), genomic markers (eg, BRCA1, BRCA2, and PIK3CA), and immunomarkers (eg, tumour-infiltrating lymphocytes and PD-L1). New biomarker combinations are the basis for increasingly complex diagnostic algorithms. Neoadjuvant combination therapy, often including targeted agents, is a standard of care (especially in HER2-positive and triple-negative breast cancer), and the basis for de-escalation of surgery in the breast and axilla and for risk-adapted post-neoadjuvant strategies. Radiotherapy remains an important cornerstone of breast cancer therapy, but de-escalation schemes have become the standard of care. ER-positive tumours are treated with 5-10 years of endocrine therapy and chemotherapy, based on an individual risk assessment. For metastatic breast cancer, standard therapy options include targeted approaches such as CDK4 and CDK6 inhibitors, PI3K inhibitors, PARP inhibitors, and anti-PD-L1 immunotherapy, depending on tumour type and molecular profile. This range of treatment options reflects the complexity of breast cancer therapy today. DOI: 10.1016/S0140-6736(20)32381-3
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