• 山東省腫瘤醫(yī)院乳腺病中心 山東省醫(yī)學(xué)科學(xué)院（濟(jì)南 250117）;

目的 探討乳腺癌新輔助化療后的腫瘤退縮模式、殘留腫瘤的影像評估以及新輔助化療后保乳手術(shù)的選擇標(biāo)準(zhǔn)。方法 綜述國內(nèi)、外有關(guān)新輔助化療后乳腺癌的臨床、影像及病理研究的文獻(xiàn)。結(jié)果 乳腺癌新輔助化療可以提高保乳的可行性，新輔助化療后腫瘤退縮模式及其相關(guān)因素尚不明確，MRI是目前新輔助化療效果最準(zhǔn)確的影像學(xué)評價(jià)方法，M.D.Anderson預(yù)后指數(shù)及美國國立癌癥研究院確定的新輔助化療后降期保乳標(biāo)準(zhǔn)有助于指導(dǎo)手術(shù)方式的選擇。結(jié)論 新輔助化療后的腫瘤退縮模式及其準(zhǔn)確的影像評估是乳腺癌新輔助化療后保乳手術(shù)選擇及降低復(fù)發(fā)率的關(guān)鍵，也是將來的研究方向。

引用本文： 劉廣,王永勝. 乳腺癌新輔助化療后保乳手術(shù)研究進(jìn)展△. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1249-1252. doi: 復(fù)制

1. Goldhirsch A, Ingle JN, Gelber RD, et al. Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009 [J]. Ann Oncol, 2009; 20(8): 1319-1329.
2. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18 [J]. J Clin Oncol, 1997; 15(7): 2483-2493.
3. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27 [J]. J Clin Oncol, 2008; 26(5): 778-785.
4. van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902 [J]. J Clin Oncol, 2001; 19(22): 4224-4237.
5. Yuan Z, Qu X, Zhang ZT, et al. Neoadjuvant chemotherapy in patients with stages Ⅱ and Ⅲ breast cancer [J]. Chin Med J (Engl), 2009; 122(24): 2993-2997.
6. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18 [J]. J Natl Cancer Inst Monogr, 2001; 30: 96-102.
7. Asoglu O, Muslumanoglu M, Igci A, et al. Breast conserving surgery after primary chemotherapy in locally advanced breast cancer [J]. Acta Chir Belg, 2005; 105(1): 62-68.
8. Mauriac L, MacGrogan G, Avril A, et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonié Bordeaux Groupe Sein (IBBGS) [J]. Ann Oncol, 1999; 10(1): 47-52.
9. Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference [J]. J Clin Oncol, 2008; 26(5): 791-797.
10. Cebrecos I, Córdoba O, Deu J, et al. Can we predict local recurrence in breast conserving surgery after neoadjuvant chemotherapy? [J]. Eur J Surg Oncol, 2010; 36(6): 528-534.
11. 李金峰, 歐陽濤, 王天峰, 等. 局部進(jìn)展期及較大乳腺癌的保乳治療 [J]. 中華外科雜志, 2005; 43(15): 1008-1010.
12. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis [J]. J Natl Cancer Inst, 2005; 97(3): 188-194.
13. Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer [J]. Cochrane Database Syst Rev, 2007; (2): CD005002.
14. Hortobagyi GN, Ames FC, Buzdar AU, et al. Management of stage Ⅲ primary breast cancer with primary chemotherapy, surgery, and radiation therapy [J]. Cancer, 1988; 62(12): 2507-2516.
15. Rajan R, Poniecka A, Smith TL, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response [J]. Cancer, 2004; 100(7): 1365-1373.
16. Akazawa K, Tamaki Y, Taguchi T, et al. Preoperative evaluation of residual tumor extent by three-dimensional magnetic resonance imaging in breast cancer patients treated with neoadjuvant chemotherapy [J]. Breast J, 2006; 12(2): 130-137.
17. Bahri S, Chen JH, Mehta RS, et al. Residual breast cancer diagnosed by MRI in patients receiving neoadjuvant chemotherapy with and without bevacizumab [J]. Ann Surg Oncol, 2009; 16(6): 1619-1628.
18. Kim HJ, Im YH, Han BK, et al. Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: relation to response patterns on MRI [J]. Acta Oncologica, 2007; 46(7): 996-1003.
19. Peintinger F, Kuerer HM, McGuire SE, et al. Residual specimen cellularity after neoadjuvant chemotherapy for breast cancer [J]. Br J Surg, 2008; 95(4): 433-437.
20. El-Didi MH, Moneer MM, Khaled HM, et al. Pathological assessment of the response of locally advanced breast cancer to neoadjuvant chemotherapy and its implications for surgical management [J]. Surg Today, 2000; 30(3): 249-254.
21. 譚云山, 陳君雪, 紀(jì)元, 等. 乳腺癌新輔助化療后殘留癌組織的病理分析 [J]. 中國臨床醫(yī)學(xué), 2000; 7(1): 58-60.
22. Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy [J]. AJR Am J Roentgenol, 2003; 181(5): 1275-1282.
23. Warren RM, Bobrow LG, Earl HM, et al. Can breast MRI help in the management of women with breast cancer treated by neoadjuvant chemotherapy? [J]. Br J Cancer, 2004; 90(7): 1349-1360.
24. Straver ME, Loo CE, Rutgers EJ, et al. MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy [J]. Ann Surg, 2010; 251(4): 701-707.
25. Yamashiro N, Tozaki M, Ogawa T, et al. Preoperative MRI marking technique for the planning of breast-conserving surgery [J]. Breast Cancer, 2009; 16(3): 223-228.
26. Chen JH, Feig B, Agrawal G, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy [J]. Cancer, 2008; 112(1): 17-26.
27. Garimella V, Qutob O, Fox JN, et al. Recurrence rates after DCE-MRI image guided planning for breast-conserving surgery following neoadjuvant chemotherapy for locally advanced breast cancer patients [J]. Eur J Surg Oncol, 2007; 33(2): 157-161.
28. Bhattacharyya M, Ryan D, Carpenter R, et al. Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer [J]. Br J Cancer, 2008; 98(2): 289-293.
29. Wasser K, Sinn HP, Fink C, et al. Accuracy of tumor size measurement in breast cancer using MRI is influenced by histological regression induced by neoadjuvant chemotherapy [J]. Eur Radiol, 2003; 13(6): 1213-1223.
30. Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy [J]. AJR Am J Roentgenol, 2003; 181(5): 1275-1282.
31. Morris EA. Review of breast MRI: indications and limitations [J]. Semin Roentgenol, 2001; 36(3): 226-237.
32. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer [J]. N Engl J Med, 2002; 347(16): 1233-1241.
33. Sadetzki S, Oberman B, Zipple D, et al. Breast conservation after neoadjuvant chemotherapy [J]. Ann Surg Oncol, 2005; 12(6): 480-487.
34. Rouzier R, Mathieu MC, Sideris L, et al. Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors [J]. Cancer, 2004; 101(5): 918-925.
35. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience [J]. J Clin Oncol, 2004; 22(12): 2303-2312.
36. Newman LA, Buzdar AU, Singletary SE, et al. A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility [J]. Ann Surg Oncol, 2002; 9(3): 228-234.
37. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy [J]. Cancer, 2005; 103(4): 689-695.
38. Huang EH, Strom EA, Perkins GH, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score [J]. Int J Radiat Oncol Biol Phys, 2006; 66(2): 352-357.
39. Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference [J]. J Clin Oncol, 2008; 26(5): 791-797.
40. Alm El-Din MA, Taghian AG. Breast conservation therapy for patients with locally advanced breast cancer [J]. Semin Radiat Oncol, 2009; 19(4): 229-235.
  1. 1. Goldhirsch A, Ingle JN, Gelber RD, et al. Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009 [J]. Ann Oncol, 2009; 20(8): 1319-1329.
  2. 2. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18 [J]. J Clin Oncol, 1997; 15(7): 2483-2493.
  3. 3. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27 [J]. J Clin Oncol, 2008; 26(5): 778-785.
  4. 4. van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902 [J]. J Clin Oncol, 2001; 19(22): 4224-4237.
  5. 5. Yuan Z, Qu X, Zhang ZT, et al. Neoadjuvant chemotherapy in patients with stages Ⅱ and Ⅲ breast cancer [J]. Chin Med J (Engl), 2009; 122(24): 2993-2997.
  6. 6. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18 [J]. J Natl Cancer Inst Monogr, 2001; 30: 96-102.
  7. 7. Asoglu O, Muslumanoglu M, Igci A, et al. Breast conserving surgery after primary chemotherapy in locally advanced breast cancer [J]. Acta Chir Belg, 2005; 105(1): 62-68.
  8. 8. Mauriac L, MacGrogan G, Avril A, et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonié Bordeaux Groupe Sein (IBBGS) [J]. Ann Oncol, 1999; 10(1): 47-52.
  9. 9. Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference [J]. J Clin Oncol, 2008; 26(5): 791-797.
  10. 10. Cebrecos I, Córdoba O, Deu J, et al. Can we predict local recurrence in breast conserving surgery after neoadjuvant chemotherapy? [J]. Eur J Surg Oncol, 2010; 36(6): 528-534.
  11. 11. 李金峰, 歐陽濤, 王天峰, 等. 局部進(jìn)展期及較大乳腺癌的保乳治療 [J]. 中華外科雜志, 2005; 43(15): 1008-1010.
  12. 12. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis [J]. J Natl Cancer Inst, 2005; 97(3): 188-194.
  13. 13. Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer [J]. Cochrane Database Syst Rev, 2007; (2): CD005002.
  14. 14. Hortobagyi GN, Ames FC, Buzdar AU, et al. Management of stage Ⅲ primary breast cancer with primary chemotherapy, surgery, and radiation therapy [J]. Cancer, 1988; 62(12): 2507-2516.
  15. 15. Rajan R, Poniecka A, Smith TL, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response [J]. Cancer, 2004; 100(7): 1365-1373.
  16. 16. Akazawa K, Tamaki Y, Taguchi T, et al. Preoperative evaluation of residual tumor extent by three-dimensional magnetic resonance imaging in breast cancer patients treated with neoadjuvant chemotherapy [J]. Breast J, 2006; 12(2): 130-137.
  17. 17. Bahri S, Chen JH, Mehta RS, et al. Residual breast cancer diagnosed by MRI in patients receiving neoadjuvant chemotherapy with and without bevacizumab [J]. Ann Surg Oncol, 2009; 16(6): 1619-1628.
  18. 18. Kim HJ, Im YH, Han BK, et al. Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: relation to response patterns on MRI [J]. Acta Oncologica, 2007; 46(7): 996-1003.
  19. 19. Peintinger F, Kuerer HM, McGuire SE, et al. Residual specimen cellularity after neoadjuvant chemotherapy for breast cancer [J]. Br J Surg, 2008; 95(4): 433-437.
  20. 20. El-Didi MH, Moneer MM, Khaled HM, et al. Pathological assessment of the response of locally advanced breast cancer to neoadjuvant chemotherapy and its implications for surgical management [J]. Surg Today, 2000; 30(3): 249-254.
  21. 21. 譚云山, 陳君雪, 紀(jì)元, 等. 乳腺癌新輔助化療后殘留癌組織的病理分析 [J]. 中國臨床醫(yī)學(xué), 2000; 7(1): 58-60.
  22. 22. Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy [J]. AJR Am J Roentgenol, 2003; 181(5): 1275-1282.
  23. 23. Warren RM, Bobrow LG, Earl HM, et al. Can breast MRI help in the management of women with breast cancer treated by neoadjuvant chemotherapy? [J]. Br J Cancer, 2004; 90(7): 1349-1360.
  24. 24. Straver ME, Loo CE, Rutgers EJ, et al. MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy [J]. Ann Surg, 2010; 251(4): 701-707.
  25. 25. Yamashiro N, Tozaki M, Ogawa T, et al. Preoperative MRI marking technique for the planning of breast-conserving surgery [J]. Breast Cancer, 2009; 16(3): 223-228.
  26. 26. Chen JH, Feig B, Agrawal G, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy [J]. Cancer, 2008; 112(1): 17-26.
  27. 27. Garimella V, Qutob O, Fox JN, et al. Recurrence rates after DCE-MRI image guided planning for breast-conserving surgery following neoadjuvant chemotherapy for locally advanced breast cancer patients [J]. Eur J Surg Oncol, 2007; 33(2): 157-161.
  28. 28. Bhattacharyya M, Ryan D, Carpenter R, et al. Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer [J]. Br J Cancer, 2008; 98(2): 289-293.
  29. 29. Wasser K, Sinn HP, Fink C, et al. Accuracy of tumor size measurement in breast cancer using MRI is influenced by histological regression induced by neoadjuvant chemotherapy [J]. Eur Radiol, 2003; 13(6): 1213-1223.
  30. 30. Rosen EL, Blackwell KL, Baker JA, et al. Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy [J]. AJR Am J Roentgenol, 2003; 181(5): 1275-1282.
  31. 31. Morris EA. Review of breast MRI: indications and limitations [J]. Semin Roentgenol, 2001; 36(3): 226-237.
  32. 32. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer [J]. N Engl J Med, 2002; 347(16): 1233-1241.
  33. 33. Sadetzki S, Oberman B, Zipple D, et al. Breast conservation after neoadjuvant chemotherapy [J]. Ann Surg Oncol, 2005; 12(6): 480-487.
  34. 34. Rouzier R, Mathieu MC, Sideris L, et al. Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors [J]. Cancer, 2004; 101(5): 918-925.
  35. 35. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience [J]. J Clin Oncol, 2004; 22(12): 2303-2312.
  36. 36. Newman LA, Buzdar AU, Singletary SE, et al. A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility [J]. Ann Surg Oncol, 2002; 9(3): 228-234.
  37. 37. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy [J]. Cancer, 2005; 103(4): 689-695.
  38. 38. Huang EH, Strom EA, Perkins GH, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score [J]. Int J Radiat Oncol Biol Phys, 2006; 66(2): 352-357.
  39. 39. Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference [J]. J Clin Oncol, 2008; 26(5): 791-797.
  40. 40. Alm El-Din MA, Taghian AG. Breast conservation therapy for patients with locally advanced breast cancer [J]. Semin Radiat Oncol, 2009; 19(4): 229-235.