关于“中国进展期乳腺癌治疗指南草案”

对于早期乳腺癌的指南和共识有很多,而且论述足够详尽,很好地指导和规范了临床医生的实践,但对于进展期乳腺癌,相应的指南还不够详尽,有很多方面亟须完善,原因可能是这类患者的治疗效果不尽如人意,以及治疗时间和治疗费用的增加,影响了针对这类患者的治疗指南的制定和推广,国内多年从事乳腺癌领域临床和基础研究工作的专家根据国际和国内进展期乳腺癌的各类治疗指南（包括中国抗癌协会乳腺癌专业委员会指南、     

2011年《St．Gallen早期乳腺癌初始治疗国际专家共识》与中国抗癌协会乳腺癌专业委员会指南之比较

2011年6月《AnnalsofOncology}杂志公布了最新版《St．Gallen早期乳腺癌初始治疗国际专家共识》（以下简称《St．Gallen共识》）。与此同时,中国抗癌协会乳腺癌专业委员会（CBCS）也更新了《乳腺癌诊治指南与规范》（以下简称《CBCS指南》）。现将两部指南的主要更新点作一介绍。     

HER-2阳性晚期乳腺癌治疗策略

近十年来,由于多个抗HER-2药物成功研发上市,HER-2阳性晚期乳腺癌成为证据级别最高、治疗方案最成熟的晚期乳腺癌生物学亚型,抑制HER-2通路是HER-2阳性晚期乳腺癌患者一线治疗及一线治疗进展后的基础治疗。《中国肿瘤临床》2016年第10期“专家共识”栏目中,来自中国医学科学院肿瘤医院肿瘤内科的张频教授结合国内外研究进展及治疗指南/共识,介绍HER-2阳性晚期乳腺癌治疗相关的关键临床研究、指南推荐及今后的研究方向,以期指导临床实践。     

中国抗癌协会乳腺癌诊治指南与规范（2019年版）

1　乳腺癌筛查指南（附录Ⅰ） 2　常规乳腺X线检查和报告规范（附录Ⅱ） 3　乳腺超声检查和报告规范（附录Ⅲ） 4　常规乳腺MRI检查和报告规范（附录Ⅳ） 5　影像引导下的乳腺组织学活检指南 6　乳腺癌术后病理学诊断报告规范（附录Ⅴ） 7　浸润性乳腺癌保乳治疗临床指南 8　乳腺癌前哨淋巴结活检临床指南 9　乳腺癌全乳切除术后放疗临床指南 10　乳腺癌全身治疗指南 11　乳腺癌患者随访与康复共识 12　乳房重建与整形临床指南 13　乳腺原位癌治疗指南 14　HER2阳性乳腺癌临床诊疗专家共识 15　乳腺癌局部和区域淋巴结复发诊治指南 16　乳腺癌骨转移的临床诊疗指南 17 乳腺癌患者BRCA1/2基因检测与临床应用 18 乳腺癌多基因精准检测指南 附　　录     

浙江省乳腺癌新辅助治疗专家共识（2018）

摘 要：乳腺癌新辅助治疗是局部晚期乳腺癌和可手术乳腺癌的重要治疗方式。乳腺癌新辅助临床诊治尽管已取得很多进展,但仍然面临诸多争议,有必要对乳腺癌的新辅助治疗形成共识。在结合2018年的共识投票基础上,综合新辅助诊治的研究结果,浙江省医学会外科学分会和浙江省医师协会乳腺肿瘤专业委员会联合发布《浙江省乳腺癌新辅助治疗专家共识（2018）》。共识结合了理论与实践,针对乳腺癌新辅助治疗的适应证与意义、新辅助治疗的评估、新辅助治疗的方案和新辅助治疗完成后的局部区域治疗四个方面进行原则性总结并详细阐释,同时附以共识投票结果,以期更好地指导乳腺癌的新辅助临床诊治。     

基于AGREE-China对中文乳腺癌诊治相关指南/共识的质量评估

摘 要：［目的］ 评估中文乳腺癌诊治相关指南/共识类论文的质量,并基于评价结果提出编辑决策。［方法］ 通过知网、万方、维普三大中文数据库检索2019—2020年间发表的中文乳腺癌诊治相关指南/共识类论文,并采用AGREE-China质量评价工具对上述论文进行质量评价,同时向乳腺癌领域专家发放问卷,对上述论文进行质量评价。采用SPSS22.0对数据结果进行统计处理,AGREE-China评分结果采用区组设计方差分析,计量资料采用t检验或Spearman相关分析。［结果］ 经遴选后,共23篇中文乳腺癌诊治相关指南/共识类论文纳入到本研究,总体有较高的被引频次（52.2%的论文被引超过10次）和下载次数（65.2%的论文下载超过500次）。然而AGREE-China总体得分不高（平均21.7分,5.5～70.3分,满分100分）,论文获得推荐情况较弱。而乳腺癌领域专家评价结果显示,该类论文获得乳腺癌领域专家的认可度较高（平均8.0分,7.0～9.4分,满分10分）。统计分析显示：AGREE-China总分、被引频次、下载次数和专家评分之间呈正相关;AGREE-China总分、专家评分、被引频次和下载次数与指南/共识作者类型和所发表的期刊类型均无关;定期更新的医学指南/共识类论文相比未更新者有较高的被引频次、下载次数和专家评分（P<0.05）,但在AGREE-China总分方面差异无统计学意义（P>0.05）。［结论］ 中文乳腺癌诊治相关指南/共识制定和发表时未有效参考方法学内容,AGREE-China评价得分较低,但仍然受到该领域学者的认可。期刊编辑应该加强医学指南/共识制定和发表的知识学习和储备,发挥主观能动性,尽可能参与到医学指南/共识的制定过程中,进一步提升中文医学指南/共识类论文的整体质量。     

首届中国进展期乳腺癌共识指南(草案)

首届中国进展期乳腺癌会议暨“复发转移乳腺癌的管理和综合治疗进展学习班”于2013年8月30日到9月1日在中国北京顺利召开。本次会议为国家继续教育项目,编号2013—04—13—025（国）,由中国抗癌协会乳腺癌专业委员会和中国女医师协会临床肿瘤学专家委员会联合主办,北京大学肿瘤医院承办。进展期乳腺癌（advancedbreastcancer,ABC）与早期乳腺癌相比,没有公认的治疗标准,特别是在接受一线治疗后。     

美国临床肿瘤学会发布最新版乳腺癌骨转移治疗指南

美国临床肿瘤学会（AmericanSocietyofClinicalOncology,ASCO）在2011年29卷9期《临床肿瘤学杂志》上发表题为（（AmericanSocietyofClinicalOncologyExecutiveSummaryoftheClinicalPracticeGuidelineUpdateontheRoleofBone-ModifyingAgentsinMetastaticBreastCancer））的专题论文,发布了2011年ASCO乳腺癌骨转移治疗共识和指南。这是继ASCO2000年发布双膦酸盐应用于乳腺癌患者的临床实践指南并于2003年修订后的最近一次更新。本文就指南的主要更新内容作一简要介绍。     

乳腺癌内分泌治疗的基本共识

内分泌治疗是乳腺癌全身治疗的主要手段之一。20世纪70年代,三苯氧胺的问世成为乳腺癌内分泌药物治疗的里程碑;90年代,第3代芳香化酶抑制剂的问世则使乳腺癌的内分泌治疗进入了一个新时代。2005年1月2日,我国北方部分从事乳腺癌临床工作的专家,根据国内外学术研究进展,结合自身临床实践经验,参考乳腺癌治疗的国际指南,就内分泌治疗在乳腺癌的复发转移、术前新辅助治疗和术后辅助治疗中的作用和地位进行了讨论,并达成基本共识,由执笔者整理成文。     

中国乳腺癌筛查与早期诊断指南

中国抗癌协会乳腺癌专业委员会于2020年4月—2021年11月,采用改编《欧盟委员会乳腺癌指南》的方法,编写制定了《中国乳腺癌筛查和早期诊断指南》（后文简称指南）。指南遵循GRADE系统方法,共包括50条推荐意见和5条专家共识,涉及乳腺癌的筛查、早期诊断、复发风险基因检测以及筛查项目中的沟通和培训等专业领域。指南推荐意见的形成考虑了目前最佳循证医学证据、中国女性群体的价值观念与偏好、成本和资源配置等因素。在应用本指南推荐的筛查和诊断技术时,应结合各地实际情况。     

Reflections on 2015

The Editor-in-Chief reflects on recent advances, including CRISPR technology and the expansion of immunotherapy, and highlights trends that will be important in the coming year.Open in a separate windowBruce A. Chabner, M.D.We close a year of remarkable progress in cancer research and care, and make special note of some important trends that this journal is embracing. On the research front, I first would like to recognize two notable achievements that have changed expectations for the future. The first is clustered regularly interspaced short palindromic repeats (CRISPR) technology, which will allow excision of mutant or defective genes and insertion of a physiological alternative. Put simply, we now have the power to remake human DNA. As an example of its potential, this technology could correct inherited disorders that predispose to cancer, or could insert new genes that resist infection by carcinogenic viruses such as HIV, hepatitis B or C, human papillomavirus, or Epstein-Barr virus. Many other applications to cancer are possible. Second, we have witnessed the vast expansion of immunotherapy with checkpoint inhibitors, and the introduction to trial of a series of complementary immunotherapies (vaccines, other checkpoint inhibitors, T-cell and macrophage activators). In the coming year, we expect to learn much more about how to use these expensive drugs more efficiently, developing biomarkers that predict response, and limiting their use to patients who will benefit.At the same time, we have learned a great deal about targeted therapy and its limitations. Increasingly, we are seeing that tumors are not simple BRAF or ALK mutants but a collection of subclones that emerge down diverse pathways. Treating the drug-resistant tumor will not be a simple task. We have harvested valuable information from sequential biopsy specimens of primary tumor and have learned that drug resistance is polyclonal, complex, and daunting. Plasma DNA may prove a better picture of the diversity of mutations throughout the body than a biopsy specimen from a single site. Other uses of plasma DNA monitoring are appealing. For example, plasma sampling after local treatment may be able to predict who among adjuvant-treatment candidates is likely to recur after local therapy. We will be featuring molecular tumor board papers that aid the reader in interpreting results of these and other molecular assays, and in choosing new treatments based on these findings. Despite the enormity of the problem of resistance, the contribution of targeted therapy has been profound, providing treatment options for otherwise incurable tumors.What about the early trials that fail or lead to equivocal results? These results deserve to see the light of day. I would like to note that our Clinical Trial Results (CTR) section, chaired by Susan Bates and Tito Fojo, continues to provide a much-needed path to publication of early clinical trial results. The failure to publish many valuable trials has awakened the attention of Congress and the National Cancer Institute. There is no reason not to publish these trials, given the support available online from CTR.We must celebrate the contribution of the Food and Drug Administration and its leadership in adapting to these developments. Nearly 20 new cancer treatments were approved last year, accounting for approximately 40% of FDA''s total approvals in 2015, a remarkable number considering the slow progress in the past. Many of these were approved along the new Breakthrough path after only 3 years of testing. It is difficult to understand the anger and denigration expressed by those who would favor unrestrained access to any medicine approved overseas.I would like to acknowledge the growing interest in community outreach and equity of care. Not all cancer victims in the United States or abroad have access to the molecular tests, targeted drugs, and immunotherapies featured in the scientific papers that grace our journals. There are serious gaps in practice and access to care at home and abroad. Our new section on Community Outreach, chaired by Beverly Moy and Michele Evans, will encourage papers in this emerging area of concern. The rising costs of cancer medicines present a new challenge to patients, physicians, private payers, and governments. Bernardo Goulart, Carlo La Vecchia, and Dan Goldstein will address this critical topic—the cost and value of cancer care—in the coming months in a series of papers from noted experts in the field. Likewise, this journal and others have recognized the need to broaden our vision to include global oncology, as the majority of cancer cases and deaths occur in low- and middle-income countries, where cancer diagnosis and care is rudimentary. We invite contributions to all of these new initiatives.Finally, I would like to thank our reviewers, section editors, and contributors. I hope that we have provided a valuable forum for publishing the timeliest developments and issues in this fast-changing field of cancer care, in all its dimensions.     

Cancer statistics, 2015

Each year the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. A total of 1,658,370 new cancer cases and 589,430 cancer deaths are projected to occur in the United States in 2015. During the most recent 5 years for which there are data (2007‐2011), delay‐adjusted cancer incidence rates (13 oldest SEER registries) declined by 1.8% per year in men and were stable in women, while cancer death rates nationwide decreased by 1.8% per year in men and by 1.4% per year in women. The overall cancer death rate decreased from 215.1 (per 100,000 population) in 1991 to 168.7 in 2011, a total relative decline of 22%. However, the magnitude of the decline varied by state, and was generally lowest in the South (～15%) and highest in the Northeast (≥20%). For example, there were declines of 25% to 30% in Maryland, New Jersey, Massachusetts, New York, and Delaware, which collectively averted 29,000 cancer deaths in 2011 as a result of this progress. Further gains can be accelerated by applying existing cancer control knowledge across all segments of the population. CA Cancer J Clin 2015;65:5–29. © 2015 American Cancer Society.