Surgery paradigm for locally advanced breast cancer following neoadjuvant systemic therapy

IF 1.6 4区 医学 Q2 SURGERY
Ziyue Sun, Kexin Liu, Yanru Guo, Nanyuan Jiang, Meina Ye
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Abstract

Locally advanced breast cancer (LABC) remains a significant clinical challenge, particularly in developing countries. While neoadjuvant systemic therapy (NST) has improved the pathological complete response (pCR) rates, particularly in HER2-positive and triple-negative breast cancer patients, surgical management post-NST continues to evolve. The feasibility of omitting surgery and the increasing consideration of breast-conserving surgery, immediate reconstruction in LABC patients are important areas of exploration. Accurate assessment of tumor response to NST through advanced imaging and minimally invasive biopsies remains pivotal, though challenges persist in reliably predicting pCR. Additionally, axillary lymph node management continues to evolve, with emerging strategies aiming to minimize the extent of surgery in patients who achieve nodal downstaging post-NST. Minimizing axillary lymph node dissection in favor of less invasive approaches is gaining attention, though further evidence is needed to establish its oncological safety. The potential for personalized treatment approaches, reducing surgical morbidity, and improving quality of life are key goals in managing LABC, while maintaining the priority of achieving favorable long-term outcomes.
新辅助系统疗法后局部晚期乳腺癌的手术范例
局部晚期乳腺癌(LABC)仍然是一项重大的临床挑战,尤其是在发展中国家。虽然新辅助系统治疗(NST)提高了病理完全反应率(pCR),尤其是对 HER2 阳性和三阴性乳腺癌患者,但 NST 后的手术治疗仍在不断发展。省略手术的可行性以及越来越多的 LABC 患者开始考虑保乳手术和即刻重建,这些都是需要探索的重要领域。通过先进的成像技术和微创活检准确评估肿瘤对 NST 的反应仍然至关重要,但在可靠预测 pCR 方面仍然存在挑战。此外,腋窝淋巴结管理也在不断发展,新出现的策略旨在最大限度地减少 NST 后实现结节下移的患者的手术范围。尽量减少腋窝淋巴结清扫,转而采用创伤较小的方法正受到越来越多的关注,尽管还需要进一步的证据来确定其肿瘤安全性。个性化治疗方法的潜力、降低手术发病率和提高生活质量是治疗 LABC 的关键目标,同时也是实现良好的长期预后的首要任务。
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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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