免疫检查点抑制剂在乳腺癌免疫治疗中应用进展

乳腺癌已成为全球发病率最高的癌症，其异质性使得乳腺癌分类治疗进入了精准治疗时代。随着肿瘤免疫治疗的成功，既往被认为“弱免疫原性”的乳腺癌也跨入了免疫治疗阶段。目前，免疫检查点抑制剂在乳腺癌免疫治疗的临床应用中取得了重大进展，但乳腺癌免疫治疗单药的获益人群有限，联合方案成为新的研究热点。随着免疫检查点抑制剂在乳腺癌中的研究进展，有效联合免疫治疗和化疗可能提高乳腺癌病人的生存率，但用药时机和适用人群仍需合理评估。免疫治疗在乳腺癌中既有应用前景，也存在挑战。     

晚期乳腺癌外科治疗新进展与抗癌观念若干改变

乳腺癌是女性常见的恶性肿瘤之一,对女性健康和生命构成了严重威胁。早期乳腺癌预后良好,而晚期乳腺癌曾被看成是不可治愈的疾病。绝大多数晚期乳腺癌生存期不超过5年。众所周知,乳腺癌是一种需要综合治疗的全身性疾病,治疗手段包括：手术、化疗、内分泌治疗、放疗、靶向治疗及免疫治疗等。     

乳腺癌生物免疫治疗的临床应用研究进展与展望

乳腺癌是女性常见的恶性肿瘤,虽然手术、放疗、化疗和内分泌治疗取得了很大的进展,但对于进展期和转移的乳腺癌却仍没有有效的治疗手段,随着分子生物学、细胞生物学和免疫学研究的进展,生物免疫治疗已成为一种新的治疗手段。在大量实验研究的基础上,近年来已有一些生物免疫治疗方法应用于临床试验中。     

早期可手术乳腺癌的诊治现状与展望

<正>乳腺癌是一种“全身性疾病”理论的提出与实践,使其从单一的局部治疗,发展到以手术为基础,包含放疗、内分泌治疗、化疗、靶向治疗和免疫治疗等的综合治疗模式^[1]。进入本世纪后,在综合治疗基础上,笔者进一步探索早期乳腺癌最优诊治流程和方案。早期乳腺癌目前无明确的定义,本文提及的早期乳腺癌主要指可手术的非局部晚期乳腺癌。     

铜死亡与乳腺癌相关性的研究进展

目的 总结铜及铜死亡机制在乳腺癌领域的最新进展,为临床治疗决策提供参考。方法 查阅近年来铜及铜死亡相关文献,对铜在乳腺癌中的作用及铜死亡机制应用于乳腺癌诊疗的研究进展进行综述。结果 铜死亡是新发现的一种程序性细胞死亡形式,通过与三羧酸循环的脂酰化成分相结合,导致脂酰化蛋白质聚集和随后的铁簇硫蛋白丢失,从而导致蛋白质毒性应激并最终导致细胞死亡。铜死亡可诱导乳腺癌细胞的增殖和迁移,介导个性化免疫治疗,参与内分泌治疗及化疗药物耐药。结论 铜死亡在乳腺癌后续免疫治疗、内分泌治疗及化疗中具有潜在的应用前景,可能为乳腺癌患者带来新的有效策略。     

乳腺癌治疗的新进展

【摘要】〓乳腺癌是女性常见的恶性肿瘤。随着医学技术的发展以及乳腺癌早期诊断率的提高,乳腺癌的治疗由最早的乳腺癌根治术(包括全乳切除)发展为以保乳手术为主的手术治疗,同时辅助以化疗、内分泌治疗、放疗、靶向治疗及免疫治疗等综合治疗。本文将对乳腺癌的治疗进展进行综述。     

乳腺癌治疗性疫苗临床研究进展

乳腺癌是女性最常见的肿瘤相关性死亡原因之一,全世界每年约有135万妇女发生乳腺癌,约33万妇女死于乳腺癌[1]。对于乳腺癌的非手术治疗,近年来国内、外都有大量的实验研究,取得了很大进展,除了传统的化疗、放疗、内分泌治疗,乳腺癌的免疫治疗已成为当今研究重点。被动免疫     

早期乳腺癌治疗10个热点问题的冷思考

随着靶向治疗、免疫治疗的普及,早期乳腺癌治疗规范程度不断提高,患者无病生存时间亦不断延长。尽管现有指南和共识为临床决策提供了依据,但临床实践中仍存在有争议的问题,包括治疗理念、文献解读程度、产品适应证和可及性等,均影响着早期乳腺癌诊疗的规范性。2021年,药品新适应证的获批、靶向药物的普及等,进一步推动着早期乳腺癌治疗...     

PD-1与PD-L1抑制剂在非转移性三阴性乳腺癌新辅助治疗应用进展

三阴性乳腺癌(TNBC)病人肿瘤浸润性淋巴细胞(TILs)表达水平与活性明显高于其他乳腺癌亚型。多项临床试验表明,程序性死亡受体-1(PD-1)及程序性死亡受体配体-1(PD-L1)抑制剂在非转移性TNBC新辅助治疗阶段取得出色的治疗结果。此外,新辅助治疗阶段降低化疗强度联合免疫治疗或去化疗的双免疫治疗有较好的治疗前景,可能是未来发展趋势。不同于转移性TNBC,PD-L1在非转移性TNBC新辅助治疗疗效的特异度与敏感度较低,未来需结合其他免疫标记物,细化TNBC分型,有针对性地选择可从免疫治疗中获益的人群,进一步提高PD-1和(或)PD-L1抑制剂的疗效价值,从而实现TNBC的精准治疗。     

乳腺癌的免疫治疗进展

<正>乳腺癌是全世界女性发病率和死亡率最高的恶性肿瘤。近年来,包括手术、化疗、内分泌治疗和放疗等的一系列综合治疗使得早期乳腺癌病人的5年生存率提高到80%～90%。但是整体而言,早期乳腺癌仍有30%～40%的病人会在术后长达15～20年的时间内出现复发或转移,而晚期乳腺癌基本上是不可治愈的疾病,严重威胁病人的生命。现有的各种治疗方式已经接近其疗效的瓶颈,对于进一步提高乳腺癌的疗效效果有限。免疫治疗是与以往针对肿瘤细胞的治疗完全不同的一类全     

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??Biological subtype of breast cancer and treatment as well as prognosis ZHAO Yi, DENG Xin. Department of Pancreatic and Breast Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author: ZHAO Yi, E-mail: zhaoy5@sj-hospital.org
Abstract With the development of early diagnosis and comprehensive treatment for breast cancer, the incidence of breast cancer is rising. Though the mortality of breast cancer declines, it remains one of the deadly diseases for woman. The prognosis of breast cancer with the same pathology type and clinical stage differs greatly even the treatment is same. It suggests highly heterogenicity of the breast cancer. The simply TNM stage based on anatomy and histology grade is not sufficient for the current breast cancer treatment. Especially need for breast cancer biological subtype based on molecular level which can suggest the clinical behavior and guide the treatment is the current research focus. It indicates that the treatment of breast cancer has entered the age of advocating individualized treatment on the basis of the standard multidisciplinary treatment.     

乳腺癌分子分型与治疗策略

随着乳腺癌早期诊断及综合治疗水平的提高,乳腺癌发病率日趋升高,其病死率虽有所下降,但仍是女性病死率最高的致死性疾病。相同病理类型及相同临床分期的乳腺癌,即使经历相同的治疗过程其预后仍然有较大差异,表明乳腺癌存在高度的异质性。作为分子高度异质性疾病,沿用的解剖学分期和组织学分类已不能满足其目前的临床诊治需求,尤其缺少能够标志肿瘤生物学行为并对临床治疗提供指导作用的乳腺癌组织学分类方法。分子水平联合组织学分类研究乳腺癌的发病机制、治疗及预后成为当前的研究热点,标志着乳腺癌的治疗进入到个体化治疗的时代。     

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??Development and indication of surgical treatment for breast cancer JIANG Jun. Breast Disease Center, Southwest Hospital, the Third Military Medical University, Chongqing 400038??China
Abstract The standard surgical treatment of breast cancer has gone through more than 100 years. The concepts and methods of surgical treatment have undergone many significant changes, and affected the clinical treatment outcome of breast cancer directly. All of the surgical changes are based on the improvement of research on the biological behavior of breast cancer and diagnosis and treatment level of breast cancer. With the new theory and technology support and accompanying with comprehensive and standard treatment, individualization, minimal invasion, precision, function protection and physical and psychological rehabilitation will be paid more and more attention for breast cancer surgery.     

乳腺癌肝转移特征及诊疗

乳腺癌发病人数逐年攀升,相较于其他部位转移的患者,乳腺癌肝转移患者通常预后较差.目前国内外尚无针对乳腺癌肝转移诊疗的指南.本文旨在为乳腺癌肝转移的临床诊疗提供一定的思路和依据.本文对乳腺癌肝转移临床特点、发病机制的研究现状与治疗进展进行综述.早期肝转移患者往往没有明显症状或体征,考虑肝转移的患者最好行影像学引导下穿刺确...     

整形技术在乳腺癌乳房再造治疗中的应用

乳腺癌作为多发的恶性肿瘤疾病之一,临床常采用手术方式进行治疗。近年来,国内的医学诊 断和治疗技术不断得到提高,乳腺癌的手术诊疗手段也有很大的进展。但由于部分患者切除了病变乳房, 生理及精神均受到不同程度的创伤。因此,整形外科诊疗技术在乳腺癌治疗中被广泛使用,在解决患者癌 症病灶的同时能够兼顾患者的生理形态美,保证患者生活质量。基于此,本文就乳房再造术、乳房重建手 术类型及其辅助技术作一综述,旨在为乳腺癌患者的相关手术治疗提供参考     

How not to neglect the care of elderly breast cancer patients?

Breast cancer is one of the leading causes of cancer mortality in women. Its incidence increases with increasing age; those over 70 years constitute more than one-third of the current breast cancer population. Despite significant advances in the field of breast cancer treatment, elderly patients have seen neither a meaningful improvement in treatment strategies, nor a decline in breast cancer-specific mortality. Studies have shown that a high percentage of elderly breast cancer patients do not receive standard treatment because of their age, co-morbidities, and sometimes due to their personal choice. However, in routine clinical practice there is no comprehensive assessment in place, on which to base treatment decisions, to ensure that elderly patients receive clinically appropriate treatment. We have reviewed the current literature and discuss differences in treatment of breast cancer between young and older patients. We also discuss different ways to optimise the treatment of breast cancer in elderly patients and the need for further research in this area.     

Clinical decision-making in early breast cancer.

OBJECTIVE: This in-depth review of the multidisciplinary approach to early breast cancer treatment (in situ, stage I and II) will update the surgeon about the indications, risks, and benefits of breast surgery, radiation therapy, adjuvant chemotherapy and hormonal therapy, and the importance of breast reconstructive surgery. SUMMARY BACKGROUND DATA: Breast cancer will occur in one of eight women in the United States during their lifetime and is the second leading cause of death in women from cancer. The practice of multidisciplinary breast cancer treatment has become the standard of care for the majority of breast cancer patients. If the surgeon is to retain the primary coordinating role in breast cancer management, then he or she must fully understand all modalities of oncology therapy and know how to deploy them to benefit individual patients. CONCLUSIONS: This article provides a framework for making clinical decisions about the appropriate combination and sequence of treatment for various presentations of early breast cancer.     

Beauty and the beast: management of breast cancer after plastic surgery

OBJECTIVES: Cosmetic surgery procedures increase in incidence annually, with 11 million performed in 2006. Because breast cancer is the most frequently occurring malignancy in women, a personal history of cosmetic surgery in those undergoing treatment for breast cancer is becoming more common. METHODS: This review identified key studies from the PubMed database, to consolidate existing data related to treatment of breast cancer after plastic surgery. Data were reviewed for factors affecting breast cancer treatment after breast augmentation, breast reduction, abdominoplasty, and suction lipectomy. RESULTS: There are little comprehensive data on the management of breast cancer after plastic surgical procedures. Plastic surgery may affect diagnostic imaging, surgical options, and radiotherapy management. Breast augmentation and reduction are two of the most common cosmetic procedures performed and knowledge of their influence on the incidence, diagnosis, and treatment of breast cancer is important for proper management. CONCLUSIONS: Plastic surgery does not significantly affect breast cancer outcomes but does present management challenges that must be anticipated when deciding various treatment options. Knowledge of the existing literature may be helpful in discussing those options with patients and planning the multidisciplinary approach to this malignancy.     

Osteoporosis and breast cancer

Osteoporosis affects one in three women after the menopause and the incidence of osteoporotic fractures increases steadily throughout life. Breast cancer is the most common cancer in women, both before and after the menopause. In younger women, recovery from breast cancer has been achieved using aggressive chemotherapy and radiotherapy that can adversely affect bone tissue or induce premature menopause. In postmenopausal women, breast cancer and osteoporosis are common, and although both are dependent on estrogens this leads to conflicting implications for the diagnosis and treatment: estrogens reduce the risk of fractures but increase the risk of breast cancer. Estrogen supplementation is, therefore, contraindicated in patients with a history of breast cancer. Selective estrogen response modifiers (SERMs) hold great promise, as they decrease both the fracture risk via an estrogen-agonist effect on bone and the breast cancer risk via an estrogen-antagonist effect on the breast tissue. SERMs can be used after successful treatment for breast cancer. Bisphosphonates, which are potent bone resorption inhibitors, are widely used both in cancer patients and in the prevention and treatment of spinal and peripheral osteoporotic fractures. Contraindications are exceedingly rare, and the satisfactory safety profile of these agents can be expected to improve further with newly developed modes of administration. Whether the bisphosphonates currently used to treat osteoporosis (alendronate and risendronate) have beneficial effects on skeletal events related to cancer progression remains to be determined, however. In sum, selection of the optimal treatment for osteoporosis in a patient with breast cancer involves assessment of the risk/benefit ratio of each treatment option, based on patient age, other risk factors for osteoporosis, and the stage of breast cancer progression.     

乳腺癌局部复发的综合治疗

目的探讨乳腺癌术后局部复发的影响因素及与预后关系。方法回顾性分析我院近15年来治疗的乳腺癌局部复发患者87例资料。结果手术 化疗 放疗组5年生存率达到61.5%。结论综合治疗在乳腺癌局部复发治疗中占有相当重要的地位。