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1、單擊此處編輯母版標(biāo)題樣式,,單擊此處編輯母版文本樣式,,第二級(jí),,第三級(jí),,第四級(jí),,第五級(jí),,*,,*,,乳腺癌新輔助化療共識(shí)與進(jìn)展,,,,提綱,,新輔助化療的意義,,pCR作為預(yù)后替代的研究終點(diǎn),,·新輔助化療優(yōu)選人群及優(yōu)化方案,,·新輔助化療的發(fā)展,,,,早期新輔助化療的研究:新輔助vs輔助,,NSABP B-18,,可手術(shù)的,,環(huán)磷酰胺(600m,,(N=1523,,分層,,炎性乳腺癌,,HER狀態(tài)不確定,,臨床淋巴結(jié)狀態(tài),,多柔比星(60mg/m2,,11隨機(jī)化分組,,手術(shù)一環(huán)磷酰胺(600mg/m2,,多柔比星(60mg/m2,,環(huán)磷酰胺(600mg/m2),,手術(shù),,可手術(shù)的原發(fā)

2、性,,HER狀態(tài)未確定,,多柔比星60mg/m?),,多西他賽,,100 mg/n,,1:11隨機(jī)化分組,,多柔比星(60mg/m2),,環(huán)磷酰胺(600mg/m2),,手術(shù),,q3w4周期,,Bear H, et al. J Clin Oncol 2019: 24: 2019-2027 Rastogi P, et al. J Clin Oncol 2019: 26: 778-785,,omark N, et al. J Natl Cancer Inst Monogr 2019: 31: 95-102.,,,,新輔助vs輔助,,NSABP B-18/B-27:術(shù)前與術(shù)后化療遠(yuǎn)期生存相似,,B-

3、1816年隨訪,,術(shù)前或術(shù)后AC方案對(duì),,099F=90,,HR=0.93P=27,,OS/DFS沒有影響,,N EvenTs,,e-Op AC,,eOp AC,,新輔助與輔助化療長,,期生存相似,,me After Random Assignment (years),,Time After Random Assignment (years),,B-278年隨訪,,術(shù)前或術(shù)后ACT方,,HR=093,097P=.4676,,H=09,02P=,2,,,案對(duì)OS/DFS沒有影,,后元,,響:新輔助與輔助化,,Pre-Op AC +Po,,1234568,,療長期生存相似,,Time After

4、Randam Assignment (ye,,Time After Random Assignment (years,,,,新輔助vs輔助,,局部復(fù)發(fā)無差異,,權(quán)重風(fēng)險(xiǎn)比,,相對(duì)風(fēng)險(xiǎn),,(固定效應(yīng)型,,乳蹤忘保乳手術(shù),,合并效應(yīng)早檢驗(yàn),,Z=074.P=046,,EORTC,,9,7%,,16.3%,,5.0%,,34411.14,,P=0.5512=0%,,并效應(yīng)早檢驗(yàn),,058.P=0.56,,合并效應(yīng)量檢驗(yàn),,Z=094.P=0,,有利于新輔助治療有利于輔助治療,,J.S.D. Meog et al, Bni'tsh oumal of Surgery 2019 94. 1289-200,

5、,,,pCR患者預(yù)后顯著優(yōu)于 non-PCR患者,,A,,0…a郵,,100春自,,E,,HR=032P≤,W1,,4H1038=0,,20,,Time After Random Assignment years),,Time After Randorm Assignment years),,B-18,,B18/B-27:pCR與OS相關(guān),,Rastogi P, et aLJ Clin Oncol. 2019 Feb 10: 26(5): 778-85,,,,新輔助治療的發(fā)展,,一、 NSABP B18/B27模式:,,選擇需要輔助化疔的人群予以統(tǒng)一的新輔助化療,,二、當(dāng)前模式,,基于分子亞型

6、給予不同新輔助治療,,三、今后模式:,,4于療效碩測腰r和分子亞型高選有效人群給予個(gè),,體化新輔助治療,,助,,2療程評(píng)佔(zhàn),,預(yù)測模,,現(xiàn)!個(gè)體化全程↓,手術(shù)(乳,,新輔助化療,,土術(shù)后放療,,空心針穿刺,,充分提高保乳保腋窩率,,CT,3Na3M",,避免無效患者喪失手術(shù)機(jī)會(huì),,影像,,探索精準(zhǔn)治療策略,,新輔助化療30%繼續(xù)4療程,,1 aIker方家療程,,↑術(shù)后化療求后放療,,史改方菜,,,,不同分子分型乳腺癌的PCR率A,,30,,Grade 1-2 Grade 3,,No Tras Yes tras,,HR+,,HER2+ HR+ HER2+ HR- TRIPLE NEG,,ort

7、aza,,NEOADJUVANTBREASTCANCERWORKSHOP,,CTNeoBC,,,,CTNeoBc:匯集分析結(jié)果,,●12項(xiàng)新輔助隨機(jī)對(duì)照研究,,究,,患者數(shù),,GBG/AGO: 7,,6377,,·明確定義了pCR,,NSABP: 2,,3171,,收集了所有需要的數(shù)據(jù),,EORTC/BIG: 1,,1856,,收集了長期EFS與OS數(shù)據(jù),,2,,總計(jì),,12993,,共納入12993例患者,,研究目的,,明確與長期預(yù)后聯(lián)系最密切的的pCR定義,,明確pCR與EFS,OS之間的關(guān)系,,確定pCR與長期預(yù)后聯(lián)系最緊密乳腺癌亞型,,評(píng)估不同治療組提高pCR率能否預(yù)示EFS和OS提升

8、,,Cortazar P, et al. Lancet, 2019, (13): 62422-8,,,,薈萃分析結(jié)果同樣顯示獲得pCR的,,患者預(yù)后更好,,Event-free Survival,,Overall Survival,,∞oo寸,,HR=048,P*,,w-2>=0,,HR=036,P*<0001,,pcR(n=2131,,cR(n=2131),,no pCR(n=9824),,no pCR(n=9824),,T,,50100150200,,Months since randomization,,Individual patients who attain a pcr have a more favorable,,pCR=ypTo/is ypNO,,long-term outcome,,Nominal p-value,,NEOADJUVANT BREAST CANCER WORKSHOP,,CTNeoBc,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,