新辅助治疗后乳腺癌病理完全缓解的评估困境与手术降阶梯策略研究进展
New Advances in the Assessment of Pathologic Complete Response and Surgical De-Escalation Strategies after Neoadjuvant Therapy for Breast Cancer
摘要: 本文旨在综述新辅助治疗后乳腺癌病理完全缓解(pCR)评估所面临的影像学、病理取样与肿瘤生物学异质性挑战，系统评析放射组学、深度学习、多模态影像、液体活检(ctDNA)与多组学融合在pCR预测及其向腋窝与乳房手术降阶转换中取得的进展与局限。并指出pCR与长期预后在分子亚型间差异显著，单一指标难以作为普适降阶依据，因而需依托标准化影像/病理流程、多源数据融合与可解释性模型构建风险分层，并通过分层化、前瞻性多中心随机试验验证降阶策略的肿瘤学安全性和长期结局，最终实现以证据为本的个体化手术减侵入化路径。
Abstract: This review aims to summarize the challenges in assessing pathologic complete response (pCR) after neoadjuvant therapy for breast cancer, including limitations in imaging, pathological sampling, and tumor biological heterogeneity. It systematically reviews the advances and limitations of radiomics, deep learning, multimodal imaging, liquid biopsy (e.g., ctDNA), and multi-omics integration in predicting pCR and its role in guiding de-escalation of axillary and breast surgery. The article highlights that the association between pCR and long-term prognosis varies significantly across molecular subtypes, and a single indicator is insufficient as a universal basis for de-escalation. Therefore, it is necessary to establish risk stratification through standardized imaging/pathology workflows, multi-source data fusion, and interpretable models. Furthermore, stratified, prospective, multicenter randomized trials are needed to validate the oncological safety and long-term outcomes of de-escalation strategies, ultimately paving the way for evidence-based, minimally invasive surgical approaches.
文章引用：王秋雨, 马泳之, 岳林皓, 陈雨佳, 贾中明. 新辅助治疗后乳腺癌病理完全缓解的评估困境与手术降阶梯策略研究进展[J]. 临床医学进展, 2026, 16(2): 1456-1467. https://doi.org/10.12677/acm.2026.162533

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