乳腺癌新辅助化疗疗效评估

Efficacy evaluation of neoadjuvant chemotherapy in breast cancer

目的通过对比乳腺癌新辅助化疗(NAC)现有规范的多个评估程序,提出未来发展方向,从而准确评估NAC的疗效。方法以“乳腺癌、新辅助治疗、新辅助化疗、病理完全缓解和疗效评估”为中文关键词,以“breast cancer,neoadjuvant therapy,neoadjuvant chemotherapy,pathological complete response,efficacy assessment”为英文关键词,检索PubMed和CNKI数据库1995-01-01-2023-06-30的相关文献。纳入标准:(1)乳腺癌NAC临床评估中相关影像学的研究;(2)NAC病理评估方法及其优劣性;(3)新辅助治疗(NAT)疗效评估程序。排除标准:存在以上关键词,但内容无关联的文章。根据纳入和排除标准,最终纳入56篇文献(英文48篇,中文8篇)。结果研究表明,在乳腺癌NAC后,通过精准的术前临床评估能够预测肿瘤病理反应,为后续治疗提供重要信息。而NAC后的肿瘤原发灶及淋巴结术后病理结果被视为评估的金标准,这些结果与患者的预后密切相关,为术后个体化综合治疗方案的制定提供了关键的指导。结论精准评估乳腺癌NAC疗效对于后续个体化治疗方案的选择和预测患者预后至关重要。目前存在多个评估程序,但缺乏统一性和标准性。因此,未来或可通过建立统一的评估指标和标准,寻找更精准和可靠的评估方法,进一步提高对NAC疗效的评估准确性,为乳腺癌患者的治疗决策和预后评估提供更好的支持。

Objective To provide a detailed overview of the assessment of neoadjuvant chemotherapy(NAC)efficacy in breast cancer and propose future directions by comparing existing standardized evaluation procedures to accurately evaluate NAC efficacy.Methods A comprehensive literature search was conducted in the PubMed and CNKI databases by using Chinese and English keywords such as“breast cancer,neoadjuvant therapy,neoadjuvant chemotherapy,pathological complete response,efficacy assessment”from Jan 1995 to June 2023.Inclusion criteria:(1)Studies on imaging in the clinical assessment of NAC for breast cancer;(2)Methods and merits or weakness of NAC pathological assessment;(3)Procedures for evaluating neoadjuvant therapy(NAT)efficacy.Exclusion criteria:Articles with the specified keywords but lacking relevance were excluded.A total of 56 articles were ultimately included,comprising 48 in English and 8 in Chinese,based on the established criteria.Results Research indicates that precise preoperative clinical assessment following NAC in breast cancer allows the prediction of tumor pathological response,offering crucial information for subsequent treatments.The postoperative pathology results of the primary tumor and lymph nodes after NAC are considered the gold standard for evaluation.These outcomes are closely associated with patient prognosis,providing essential guidance for formulating personalized postoperative comprehensive treatment plans.Conclusion Accurate assessment of NAC efficacy in breast cancer is crucial for selecting subsequent personalized treatment plans and predicting patient prognosis.Currently,multiple evaluation procedures are available,but lack uniformity and standards.Therefore,the establishment of unified assessment metrics and standards may enhance the precision and reliability of evaluation methods for NAC efficacy.This could further improve the accuracy of assessing NAC efficacy,providing better support for treatment decisions and prognosis evaluation in breast cancer patients.