韩 冬  莫雪莉

北京大学首钢医院乳腺疾病科

病史介绍

患者女，51岁，已绝经。

2018年超声体检：左乳外上象限结节，2.3*1.5cm，BI-RADS 5类，左乳肿物穿刺，病理：浸润性癌。

2018年9月行左乳单纯切除+左侧腋窝淋巴结清扫手术。

术后病理：乳腺浸润性导管癌，非特殊型，Ⅲ级，肿瘤大小4.5*3*3.5cm，可见脉管瘤栓，淋巴结（7/22）；pT2N2；免疫组化：ER（-），ER（-），AR（+，40%中阳），CK5/6（-）E-cadherin（3+），EGFR（-），HER2（-），Ki-67（+，30%），P53（-），TOP2A（2+）。

2018年10月起行多柔比星+环磷酰胺序贯紫杉醇密集方案化疗8周期，化疗期间副反应大，出现Ⅱ度贫血和静脉血栓。

2019年3月行术后辅助放疗。

该病例特点如下:

[1]Oakman C, Viale G, Di Leo A. Management of triple negative breast cancer [J]. Breast (Edinburgh, Scotland), 2010, 19(5): 312-21.

[2]Curigliano G, Burstein Hj, Winer Ep, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017 [J]. Annals of oncology : official journal of the European Society for Medical Oncology, 2017, 28(8): 1700-12.

[3]Von Minckwitz G, Schneeweiss A, Loibl S, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial [J]. The Lancet Oncology, 2014, 15(7): 747-56.

[4]Schmid P, Cortes J, Pusztai L, et al. Pembrolizumab for Early Triple-Negative Breast Cancer [J]. The New England journal of medicine, 2020, 382(9): 810-21.

[5]Wang X, Wang Ss, Huang H, et al. Effect of Capecitabine Maintenance Therapy Using Lower Dosage and Higher Frequency vs Observation on Disease-Free Survival Among Patients With Early-Stage Triple-Negative Breast Cancer Who Had Received Standard Treatment: The SYSUCC-001 Randomized Clinical Trial [J]. JAMA, 2021, 325(1): 50-8.

[6]Li J, Yu K, Pang D, et al. Adjuvant Capecitabine With Docetaxel and Cyclophosphamide Plus Epirubicin for Triple-Negative Breast Cancer (CBCSG010): An Open-Label, Randomized, Multicenter, Phase III Trial [J]. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2020, 38(16): 1774-84.