2010_乳腺癌.pdf
2010_乳腺癌.pdf
Copyright © National Comprehensive Cancer Network 2010. All rights reserved. “NCCN”, the NCCN logo, and “National Comprehensive Cancer Network” are registered
trademarks of the National Comprehensive Cancer Network.
The Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Breast Cancer Guideline 2010 is the Chinese adapted version of NCCN Clinical Practice Guidelines
in Oncology-Breast Cancer Guideline, V.2.2010 as permitted and endorsed by NCCN. It is the collaborative outcome of the National Comprehensive Cancer Network and
Chinese key opinion leaders of the field.
The original guideline and Chinese edition are both available at: http://www.nccn.org. To view the most recent and complete version of the guideline, go online to
www.nccn.org. These Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN.
These Guidelines are a work in progress that will be refined as often as new significant data becomes available. The NCCN Guidelines are a statement of consensus of its
authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN guideline is expected to use independent
medical judgment in the context of individual clinical circumstance to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no
warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
This publication should not be used for commercial purpose. It is provided for free to Chinese medical professions with the support of the unrestrictive educational grant
of Bristol-Myers Squibb Co. Ltd. which exerts no influence to the formation of the Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Breast Cancer
Guideline 2010.
肿瘤学临床实践指南(中国版)
2010年 第一版
© National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.
The Chinese edition 2010 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive
Cancer Network. To view the most recent and complete version of this or any other guideline, visit www.nccn.org.
乳腺癌
- ii -
NCCN ®
Robert W. Carlson, MD/Chair †
Stanford Comprehensive Cancer Center
D. Craig Allred, MD ≠
Siteman Cancer Center at Barnes-Jewish
Hospital and Washington University School
of Medicine
Benjamin O. Anderson, MD ¶
Fred Hutchinson Cancer Research
Center/Seattle Cancer Care Alliance
Harold J. Burstein, MD, PhD †
Dana-Farber/Brigham and Women's Cancer
Center
W. Bradford Carter, MD ¶
H. Lee Moffitt Cancer Center & Research
Institute
Stephen B. Edge, MD ¶
Roswell Park Cancer Institute
John K. Erban, MD †
Massachusetts General Hospital Cancer
Center
William B. Farrar, MD ¶
Arthur G. James Cancer Hospital & Richard
J. Solove Research Institute at The Ohio
State University
Andres Forero, MD ‡
University of Alabama at Birmingham
Comprehensive Cancer Center
Sharon Hermes Giordano, MD MPH †
The University of Texas M.D. Anderson Cancer
Center
NCCN乳腺癌专家组成员
†
‡
¶
≠
Ÿ
肿瘤内科
血液科/肿瘤科
肿瘤外科
病理科
整形外科
§
ξ
¥
*
肿瘤放射科
骨髓移植
患者支持
编委会成员
Lori J. Goldstein, MD †
Fox Chase Cancer Center
William J. Gradishar, MD ‡
Robert H. Lurie Comprehensive Cancer
Center of Northwestern University
Daniel F. Hayes, MD †
University of Michigan Comprehensive
Cancer Center
Clifford A. Hudis, MD †
Memorial Sloan-Kettering Cancer Center
Mohammad Jahanzeb, MD ‡
St. Jude Children’s Research Hospital/
University of Tennessee Cancer Institute
Britt-Marie Ljung, MD ≠
UCSF Helen Diller Family
Comprehensive Cancer Center
P. Kelly Marcom, MD †
Duke Comprehensive Cancer Center
Ingrid A. Mayer, MD †
Vanderbilt-Ingram Cancer Center
Beryl McCormick, MD §
Memorial Sloan-Kettering Cancer Center
Lori J. Pierce, MD §
University of Michigan Comprehensive
Cancer Center
Elizabeth C. Reed, MD †ξ
UNMC Eppley Cancer Center at The
Nebraska Medical Center
Mary Lou Smith, JD, MBA ¥
Consultant
George Somlo, MD ‡ξ
City of Hope
Neal S. Topham, MD Ÿ
Fox Chase Cancer Center
John H. Ward, MD ‡
Huntsman Cancer Institute at the University
of Utah
Eric P. Winer, MD †
Dana-Farber/Brigham and Women's Cancer
Center | Massachusetts General Hospital
Cancer Center
Antonio C. Wolff, MD †
The Sidney Kimmel Comprehensive Cancer
Center at Johns Hopkins University
NCCN ®乳腺癌
© National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.
The Chinese edition 2010 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive
Cancer Network. To view the most recent and complete version of this or any other guideline, visit www.nccn.org.
肿瘤学临床实践指南(中国版)
2010年 第一版
- i -
NCCN特别鸣谢
NCCN指南中国版专家组
召集人：
孙 燕
中国医学科学院北京协和医学院
肿瘤医院
NCCN代表：
Robert W. Carlson, MD/Chair †
Stanford Comprehensive Cancer
Center
NCCN乳腺癌临床实践指南（中国版）专家组
组长：
沈镇宙
复旦大学附属肿瘤医院
宋三泰
中国人民解放军三○七医院
成员（按拼音排序）：
陈佳艺
复旦大学附属肿瘤医院
胡夕春
复旦大学附属肿瘤医院
姜 军
第三军医大学西南医院
李惠平
北京大学第三医院
廖 宁
广东省人民医院
林桐榆
中山大学附属肿瘤医院
刘冬耕
中山大学附属肿瘤医院
罗荣城
南方医科大学南方医院
执笔人：
江泽飞
中国人民解放军三○七医院
任国胜
重庆医科大学附属第一医院
任 军
北京大学临床肿瘤学院、北京肿瘤医院
邵志敏
复旦大学附属肿瘤医院
沈坤炜
上海交通大学医学院附属瑞金医院
佟仲生
天津医科大学附属肿瘤医院
徐兵河
中国医学科学院北京协和医学院肿瘤医院
杨文涛
复旦大学附属肿瘤医院
张保宁
中国医学科学院北京协和医学院肿瘤医院
肿瘤学临床实践指南(中国版)
2010年 第一版
© National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.
The Chinese edition 2010 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive
Cancer Network. To view the most recent and complete version of this or any other guideline, visit www.nccn.org.
乳腺癌
- ii -
NCCN ®
浸润性乳腺癌（接上）：
保乳手术+放疗的禁忌证（BINV-F）........................................................................................30
术后乳房重建的原则（BINV-G）..............................................................................................31
放疗原则（BINV-H）.................................................................................................................32
辅助内分泌治疗（BINV-I）.......................................................................................................33
辅助化疗方案（BINV-J）...........................................................................................................34
绝经的定义（BINV-K）..............................................................................................................39
复发或转移性乳腺癌的内分泌治疗（BINV-L）......................................................................40
复发或转移性乳腺癌首选化疗方案（BINV-M）.....................................................................41
特殊类型
分叶状肿瘤（PHYLL-1~2） ............................................................................................................48
Paget's病（PAGET-1~2）..................................................................................................................50
炎性乳腺癌（IBC-1）.......................................................................................................................52
肿瘤分期.............................................................................................................................................53
讨论....................................................................................................................................................56
参考文献.............................................................................................................................................92
NCCN乳腺癌专家组成员
NCCN特别鸣谢
指南更新概要.......................................................................................................................................i
非浸润性乳腺癌：
小叶原位癌（LCIS-1）.................................................................................................................1
导管原位癌（DCIS-1~2，A）......................................................................................................2
浸润性乳腺癌：
临床分期为I、IIA、IIB或IIIA（仅T3，N1，M0）期的检查（BINV-1）...............................5
临床分期为I、IIA、IIB或IIIA（仅T3，N1，M0）期的局部治疗（BINV-2~3）..................6
全身辅助治疗（BINV-4~9）........................................................................................................8
激素受体阳性、HER-2阳性乳腺癌的全身辅助治疗（BINV-5）...................................9
激素受体阳性、HER-2阴性乳腺癌的全身辅助治疗（BINV-6）..................................10
激素受体阴性、HER-2阳性乳腺癌的全身辅助治疗（BINV-7）.................................11
激素受体阴性、HER-2阴性乳腺癌的全身辅助治疗（BINV-8）................................12
组织学类型良好的乳腺癌全身辅助治疗（BINV-9）.........................................................13
术前化疗指南（BINV-10~14）................................................................................................14
临床分期为IIA、IIB、IIIA（仅T3，N1，M0）期的检查（BINV-10）.........................14
临床分期为IIA、IIB、IIIA（仅T3，N1，M0）期的治疗（BINV-11~12）....................15
局部晚期浸润性乳腺癌（非炎性乳腺癌）的检查（BINV-13）.......................................17
局部晚期浸润性乳腺癌（非炎性乳腺癌）的治疗（BINV-14）.......................................18
术后的监测/随访及复发的检查或IV期乳腺癌的初次检查（BINV-15）...............................19
复发或IV期乳腺癌的治疗（BINV-16~20）....................................................................20
HER-2检测原则（BINV-A）......................................................................................................25
乳腺专用MRI检查原则（BINV-B）..........................................................................................26
外科腋窝分期——I、IIA和IIB期乳腺癌（BINV-C）.............................................................27
腋窝淋巴结分期（BINV-D）.....................................................................................................28
浸润性乳腺癌切缘状况（BINV-E）..........................................................................................29
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作为共识，NCCN肿瘤学临床实践指南反映了作者们对目前认可的治疗方法的观点，欲参考或应用这些指南的临床医师应根据个人具体的临床情况做出独立的医疗判断，以决定患者所需的护理和治疗。任何寻求使用这些指南
的病人或非医生人员应咨询医生关于它们的合理应用。
NCCN肿瘤学临床实践指南编译力求精确表达反映原版英文指南。NCCN不保证指南编译的有效性，也不承认任何无限制性的担保、表达及暗示。NCCN不担保指南编译或指南本身的精确性和完整性。NCCN不保证或担保或
陈述指南的应用及应用结果。NCCN及其成员不对涉及指南无限制性应用的任何偶然的、间接的、特殊的、惩罚性或作为结果的补偿费承担任何责任。
临床试验：NCCN认为任何肿瘤患者都可以在临床试验中得
到最佳处理，因此特别鼓励肿瘤患者参加临床试验研究。
NCCN对证据和共识的分类：
除非特别指出，NCCN对所有建议均达成2A类共识。
见NCCN对证据和共识的分类（见MS-1 第58页）
声明：
本指南中标注“※”处为
中国专家根据国内实际情
况进行明显改动或补充之
处，内容有别于英文版，
参考时请注意。
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