乳腺癌骨转移的研究进展

Research Progress in Breast Cancer Bone Metastasis

摘要: 乳腺癌(breast cancer, BC)是全球女性发病率最高的恶性肿瘤，其晚期首要并发症骨转移，是导致患者生活质量恶化与生存期缩短的关键因素。本文从发病机制、临床诊断和治疗三方面系统综述了乳腺癌骨转移领域的最新研究进展。在发病机制方面，我们超越“种子–土壤”经典理论，着重探讨了转移前微环境的建立、肿瘤细胞的代谢重编程与营养竞争(尤其是铁劫持新机制)，以及免疫微环境重塑，进而阐明骨转移的多步骤适应性本质；在临床诊断方面，归纳了影像、病理与分子技术的联合应用；在治疗方面，系统梳理了从双膦酸盐、地舒单抗等基础治疗及全身抗肿瘤策略，到中医药辅助治疗，乃至针对铁代谢等新机制的潜在靶向策略，并重申了多学科诊疗的核心地位。本文旨在为深入理解乳腺癌骨转移的复杂生物学过程及开发新型诊疗策略提供全面的理论参考。

Abstract: Breast cancer (BC) is the most prevalent malignancy among women globally, and its major complication of advanced disease is bone metastasis, which is a key factor leading to the deterioration of patients’ quality of life and shortened survival. This article systematically reviews the latest research progress in the field of breast cancer bone metastasis from three aspects: pathogenesis, clinical diagnosis and treatment. In terms of pathogenesis, we went beyond the classic theory of “seed-and-soil” and focused on the establishment of the pre-metastatic microenvironment, metabolic reprogramming and nutritional competition of tumor cells (especially the new mechanism of iron hijacking), and the remodeling of the immune microenvironment, and then elucidated the multi-step adaptive nature of bone metastasis. In terms of clinical diagnosis, the combined application of imaging, pathology and molecular technology is summarized. In terms of treatment, this paper systematically sorts out the potential targeting strategies from basic treatments such as bisphosphonates and denosumab and systemic anti-tumor strategies, to adjuvant therapy of traditional Chinese medicine, and even targeting new mechanisms such as iron metabolism, and reaffirms the core position of multidisciplinary diagnosis and treatment. This review aims to offer a comprehensive theoretical reference for understanding the complex biological process of breast cancer bone metastasis and developing new diagnosis and treatment strategies.