中国普通外科杂志2025，Vol.34Issue(11)：2335-2341,7.DOI:10.7659/j.issn.1005-6947.250557
早期乳腺癌腋窝手术降阶梯策略的研究进展与思考
Advances and reflections on de-escalation strategies for axillary surgery in early-stage breast cancer
摘要
Abstract
Axillary management for early-stage breast cancer is shifting from maximal tolerated treatment to minimal effective intervention.The introduction of sentinel lymph node biopsy(SLNB)markedly reduced surgical morbidity,and growing evidence now supports omitting axillary surgery in selected patients.The SOUND and INSEMA trials demonstrated that,among strictly defined cN0 patients assessed by high-quality imaging,omission of SLNB is non-inferior to SLNB in terms of invasive disease-free survival while significantly reducing complications such as lymphedema.In ductal carcinoma in situ,low-burden tumors,and elderly patients aged≥70 years with HR+/HER2-disease,omission of axillary staging has minimal impact on regional control and survival outcomes.Advances in imaging technologies,dedicated lymph node PET,and artificial intelligence have improved the accuracy of identifying true node-negative patients.Furthermore,highly selected HER2+/triple-negative patients who achieve breast pathologic complete response after neoadjuvant therapy may also be candidates for axillary surgery omission.Accurate patient selection remains central to safe de-escalation,although the loss of pathological staging information may influence subsequent systemic and radiation therapy decisions.With accumulating evidence and more refined assessment tools,axillary surgery is expected to evolve toward increasingly individualized and precise management.关键词
乳腺肿瘤/前哨淋巴结活组织检查/肿瘤辅助疗法/精准医学Key words
Breast Neoplasms/Sentinel Lymph Node Biopsy/Neoadjuvant Therapy/Precision Medicine分类
医药卫生引用本文复制引用
逯永晋,石志强,孙丽军,王永胜,邱鹏飞..早期乳腺癌腋窝手术降阶梯策略的研究进展与思考[J].中国普通外科杂志,2025,34(11):2335-2341,7.基金项目
国家自然科学基金资助项目(82172873) （82172873）
山东省自然科学基金资助项目(ZR2024LMB011) （ZR2024LMB011）
山东第一医科大学(山东省医学科学院)临床科研先导专项基金资助项目(607D25006). （山东省医学科学院）
