2例HER-2阳性乳腺癌综合治疗的MDT讨论及反思  

MDT discussion and rethink of comprehensive treatment for 2 cases of HER-2 positive breast cancer

作　　者：吴玉婷 Alexander Tobias Teichmann 吴斌 何丽佳 肖秀丽 陈晓梅 赵冬梅 左怀全 WU Yuting;Alexander Tobias Teichmann;WU Bin;HE Lijia;XIAO Xiuli;CHEN Xiaomei;ZHAO Dongmei;ZUO Huaiquan(Department of Breast Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Sichuan Gynecology and Breast Disease Treatment Center,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Oncology,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Pathology,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Ultrasound,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Department of Radiology,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China)

机构地区：[1]西南医科大学附属医院乳腺外科,四川泸州646000 [2]西南医科大学附属医院/四川省妇科与乳腺疾病治疗中心,四川泸州646000 [3]西南医科大学附属医院肿瘤科,四川泸州646000 [4]西南医科大学附属医院病理科,四川泸州646000 [5]西南医科大学附属医院超声科,四川泸州646000 [6]西南医科大学附属医院放射科,四川泸州646000

出　　处：《中国普外基础与临床杂志》2021年第4期500-507,共8页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨多学科协作团队(MDT)讨论在HER-2阳性乳腺癌综合治疗中的价值。方法回顾性分析西南医科大学附属医院乳腺外科经多次MDT讨论后采取综合全程治疗的2例HER-2阳性乳腺癌患者的临床病理资料。结果病例1为一32岁女性,入院时诊断为左乳非特殊类型浸润性癌cT2N1M0、ⅡB期、WHO 2级,ER(–),PR(–),HER-2(+++),Ki-67(+,20%),经MDT讨论后予以新辅助化疗6周期后疗效评估为部分缓解,给予左侧乳腺癌保乳术+腋窝淋巴结清扫术,术后分期ypT1aN1ycM0、ⅡA期,Miller-Payne分级4级,患者对于乳房外形满意,后续给予放疗及靶向治疗,目前仍处于靶向治疗期间,未见复发转移。病例2为一43岁女性,入院时诊断右乳非特殊类型浸润性癌cT3N0M0、ⅡB期、WHO 3级,ER(–),PR(–),HER-2(+++),Ki-67(+,40%),经MDT讨论后予以新辅助化疗2周期后疗效评估为疾病进展,更换2次新辅助化疗方案后疗效评估仍为疾病进展,最后经MDT讨论后给予右侧乳腺癌改良根治术,术后分期ypT4bN1ycM0、ⅢB期,Miller-Payne分级1级,后续拟给予放疗、吡咯替尼+卡培他滨辅助治疗,术后3个月电话随访,患者未遵医嘱放疗和辅助治疗,复查1次未见复发和转移。结论在精准医疗体系下,以MDT模式为基础的乳腺癌综合治疗可针对患者疾病特点、身体状况、既往诊疗、家庭情况等个体化因素为患者制定最佳的个体化治疗方案,让患者更大获益。Objective To explore the value of multidisciplinary team(MDT)discussion in the comprehensive treatment of HER-2 positive breast cancer.Method The clinical data of 2 patients with HER-2 positive breast cancer admitted to the Affiliated Hospital of Southwest Medical University after MDT discussions were analyzed retrospectively.Results Case 1 was a 32-year-old woman diagnosed with left breast non-special type invasive carcinoma at admission,cT2N1M0,stageⅡB,WHO grade 2,ER(–),PR(–),HER-2(+++),Ki-67(+,20%).After MDT discussion,the patient was treated with neoadjuvant chemotherapy for 6 cycles,and the efficacy evaluation was partial response,received left breast conserving surgery and axillary lymph node dissection(ALND),postoperative staging ypT1aN1ycM0,stageⅡA,Miller-Payne grade 4,the patient was satisfied with the shape of breast,received radiotherapy and anti-HER-2 therapy after surgery.At present,there was no recurrence and metastasis during anti-HER-2 therapy.Case 2 was diagnosed with right breast non-special type invasive carcinoma at admission,cT3N0M0,stageⅡB,WHO grade 3,ER(–),PR(–),HER-2(+++),Ki-67(+,40%),local advanced breast cancer.After MDT discussion,the patient was treated with neoadjuvant chemotherapy for 2 cycles,and the efficacy evaluation was progressive disease.After the replacement of two neoadjuvant chemotherapy regimen,the efficacy evaluation was still progressive disease.Finally after MDT discussion,the patient received right breast mastectomy and ALND,postoperative staging ypT4bN1ycM0,stageⅢB,Miller-Payne grade 1,received radiotherapy,adjuvant treatment with pyrotinib and capecitabine after surgery.The patient was followed up for 3 months by telephone,the patient did not follow the doctor’instructions,no recurrence and metastasis was found in the review.Conclusion Under the precision medical system,comprehensive treatment of breast cancer based on the MDT model could target patients’disease characteristics,physical conditions,previous diagnosis and treatment,family situation,

关 键 词：乳腺癌 综合治疗 多学科协作团队 精准医学 

分 类 号：R737.9[医药卫生—肿瘤]