+关注

手机看

微信扫一扫，随时随地看

2025 年 St. Gallen 国际乳腺癌大会共识投票结果公布！

肿瘤时间

2025-03-16 20:30

+关注

引言

St. Gallen 国际乳腺癌大会（SG-BCC）自 1985 年起由瑞士圣加仑州立医院（St. Gallen Cantonal Hospital）发起，是全球早期乳腺癌诊疗领域的权威盛会。2025 年 3 月 15 日，第 19 届 St. Gallen 国际乳腺癌大会在奥地利维也纳盛大开幕。此次大会汇聚了来自 130 多个国家的 3000 余名专家学者，共同聚焦乳腺癌精准治疗的最新进展。

自 2002 年起，大会首创了「专家投票共识」机制，通过全球顶尖专家对争议问题的深入讨论与投票，形成了具有权威性的临床指南 ——「St. Gallen 国际乳腺癌共识」，该共识对乳腺癌的诊治产生了深远影响。例如，2005 年的大会提出了基于 ER/PR/HER2/Ki-67 的分子分型体系，将乳腺癌分为 Luminal 型、HER2 阳性型及三阴性亚型，为精准治疗奠定了坚实基础。2011 年的会议进一步简化了分型方法，提出了基于免疫组化的替代指标（如 ER/PR/HER2/Ki-67），使得分子分型更易在临床中普及，推动了全球乳腺癌诊疗标准的统一。

在本届大会的最后一场会议中，由全球各地的乳腺癌专家组成的小组深入讨论了过去两年早期乳腺癌患者治疗的进展，投票产生了新的 St. Gallen 国际乳腺癌共识指南。当地时间 2025 年 3 月 15 日（星期六）08:30 至 13:00，圣加仑国际会议的共识投票环节圆满结束。

丁香园肿瘤时间特对本届大会的投票环节进行了回顾总结，完整的指南共识内容将于后续的 ESMO 官方杂志《肿瘤学年鉴》（Annals of Oncology）上正式发布。

基因检测（Genetic Testing）

●1. Genetic testing should be recommended for all patients age 70 or less, with newly diagnosed, early-stage breast cancer?

对于所有 70 岁或 70 岁以下的新诊断早期癌症患者，是否应该建议进行基因检测？

是：36% 否：64%

●2. Genetic testing should be done for all patients with newly diagnosed, early-stage triple-negative breast cancer?

是否应该对所有新诊断的早期三阴性乳腺癌患者进行基因检测？

是：83.6% 否：16.4%

●3. Genetic testing should be done for all patients age 50 or less with newly diagnosed, early-stage breast cancer.

是否所有 50 岁或 50 岁以下的新诊断早期癌症患者都应该进行基因检测？

是：77.3% 否：22.7%

●4. While the likelihood of finding pathogenic variants is low, I would favor routinely recommending genetic testing to all patients with newly diagnosed breast cancer.

虽然发现致病性变异的可能性很低，但我倾向于定期建议所有新诊断的癌症患者进行基因检测。

是：24% 否：76%

●5. In discussing local therapy for a 45-year-old woman with newly diagnosed, stage I breast cancer, I would recommend the following for management of the contralateral breast:

对于一名新诊断为 I 期乳腺癌的 45 岁女性患者进行局部治疗时，您会建议对侧乳房选择哪项治疗手段？

A:Risk reducing mastectomy +/- reconstruction

降低风险的乳房切除术+/-重建

B:Intensified screening with exam, mammogram, and breast MRI

通过检查、乳房 X 线照片和乳腺 MRI 进行强化筛查

C:Intensified screening and secondary prevention with endocrine therapy

内分泌治疗强化筛查和二级预防

D:Only regular screening if there is no other family history of breast cancer

只有在没有其他癌症家族史的情况下才进行定期筛查

5.1 known pathogenic variant in BRCA1

若患者确认存在 BRCA1 致病性突变

A:85.14% B:9.46% C:5.41% D:0%

5.2 ER+, and a known pathogenic variant in BRCA2

若患者肿瘤雌激素受体阳性且伴有 BRCA2 致病性突变

A:75.68% B:9.46% C:14.86% D:0%

5.3 ER negative, and a known pathogenic variant in BRCA2

若患者肿瘤雌激素受体阴性且伴有 BRCA2 致病性突变

A:82.43% B:16.22% C:1.35% D:0%

5.4 known pathogenic variant in PALB2

若患者存在 PALB2 致病性突变

A:51.43% B:41.43% C:7.14% D:0%

5.5 known pathogenic variant in ATM

若患者存在 ATM 致病性突变

A:4.29% B:52.86% C:11.43% D:31.43%

5.6 known pathogenic variant in CHEK2

若患者存在 CHEK2 致病性突变

A:15.49% B:70.42% C:14.08% D:0%

5.7 known pathogenic variant in CHEK2 del1100c

若患者存在 CHEK2 del1100c 致病性突变

A:16.92% B:60.00% C:12.31% D:10.77%

●6. In discussing local therapy for a 65-year-old woman with newly diagnosed, stage I breast cancer,I would recommend the same interventions as in a 45-year-old woman.

在讨论对新诊断为 I 期乳腺癌的 65 岁女性患者进行局部治疗时，你是否会针对其基因突变采取和前面投票中 45 岁女性患者选择相同的干预措施。

6.1 known pathogenic variant in BRCA1/BRCA2

若患者存在 BRCA1/BRCA2 致病性突变

是：44.44% 否：55.56%

6.2 known pathogenic variant in PALB2

若患者存在 PALB2 致病性突变

是：47.14% 否：52.86%

6.3 known pathogenic variant in ATM or CHEK2

若患者存在 ATM 或 CHEK2 致病性突变

是：59.42% 否：40.58%

●7. Would you recommend bilateral mastectomy in women with known BRCA2 mutation at age 65 or greater?

您是否建议对 65 岁或以上已知 BRCA2 突变的女性进行双侧乳房切除术？

是：39.7% 否：60.3%

●8. For a patient with known early-stage breast cancer undergoing risk-reducing bilateral mastectomy for a pathogenic BRCA1 or BRCA2 variant, the preferred surgery is:

对于已知患有早期癌症的患者，因致病性 BRCA1 或 BRCA2 突变而进行风险降低的双侧乳房切除术，首选手术为：

Bilateral nipple-sparing mastectomy with immediate reconstruction

双侧乳头保留乳房切除术并立即重建：65.2%

Bilateral skin-sparing mastectomy with immediate reconstruction

双侧皮肤保留乳房切除术并立即重建：25.8%

Bilateral mastectomy with aesthetic flat closure

双侧乳房切除术伴美学平面闭合：0%

Bilateral mastectomy with immediate reconstruction

双侧乳房切除术并立即重建：9.1%

●9. For a patient with a pathogenic BRCA1 or BRCA2 variant but no known breast tumor, the preferred risk-reducing surgery is:

对于患有致病性 BRCA1 或 BRCA2 变异但没有已知乳腺肿瘤的患者，首选的降低风险手术是：

Bilateral nipple-sparing mastectomy with immediate reconstruction

双侧乳头保留乳房切除术并立即重建：78.8%

Bilateral skin-sparing mastectomy with immediate reconstruction

双侧皮肤保留乳房切除术并立即重建：16.7%

Bilateral mastectomy with aesthetic flat closure

双侧乳房切除术伴美学平面闭合：0%

Bilateral mastectomy with immediate reconstruction

双侧乳房切除术并立即重建：4.5%

▲上下滑动查看▼

导管原位癌（Ductal carcinoma in situ）

●1. A woman was found to have calcifications on screening mammography. A core biopsy showed/identified ductal carcinoma in situ, grade 2, without evidence of invasive cancer. The DCIS is ER positive with calcifications. A breast MRI is otherwise negative. As next treatment steps, you would recommend:

一名女性在筛查乳房 X 光检查时被发现有钙化灶。病理活检结果为导管原位癌，2 级，没有浸润性癌症的证据。DCIS 呈 ER 阳性伴钙化。除此以外，乳房 MRI 结果阴性。作为下一步的治疗步骤，您建议：

A:surgery 手术治疗

B:annual surveillance,only, without surgery 仅每年体检观察，无需手术

C:endocrine therapy and annual surveillance, without surgery 每年体检+内分泌治疗，无需手术

1.1 55 years old; < 1 cm of calcifications

若患者年龄 55 岁，病灶＜1 cm

A:89.86% B:1.45% C:8.7%

1.2 55 years old, ～ 3 cm calcifications

若患者年龄 55 岁，病灶约为 3 cm

A:98.57% B:1.43% C:0%

1.3 70 years old; <1 cm of calcifications

若患者年龄 70 岁，病灶＜1 cm

A:71.64% B:8.96% C:19.40%

1.4 70 years old,～3 cm calcifications

若患者年龄 70 岁，病灶约为 3 cm

A:91.04% B:2.99% C:5.97%

●2. A woman has undergone breast conserving surgery for DCIS, grade 2, measuring 1-2 cm, that is ER positive. As adjuvant therapy you would recommend:

一名女性接受了 DCIS 保乳手术，术后病理结果为：2 级 DICS；1-2 厘米；ER 阳性。根据患者年龄段，您建议的辅助治疗方案为：

A.radiation therapy 放疗

B.radiation therapy and endocrine therapy (e.g.tamoxifen or an Al) 放疗+内分泌治疗（他莫昔芬或芳香化酶抑制剂 [AI]）

C.annual surveillance 每年的体检观察

2.1 40 years old 若患者 40 岁

A:33.33% B:63.77% C:2.90%

2.2 55 years old 若患者 55 岁

A:39.71% B:58.82% C:1.47%

2.3 70 years old 若患者 70 岁

A:36.23% B:27.54% C:36.23%

●3. In a healthy, non-elderly patient with fully excised DCIS, grade 2, that is ER positive, the DCIS size threshold that would make you recommend radiation therapy instead of only surveillance would be:

对于完全切除 DCIS（2 级，即 ER 阳性）的健康非老年患者，DCIS 大小阈值为多少的情况下，您将推荐放射治疗而不仅仅是监测：

Ⅰ：所有患者都进行放疗 39.39%；Ⅱ：肿瘤 0.3 cm 48.48%；Ⅲ：肿瘤 1 cm 77.27%；Ⅳ：肿瘤 2.5 cm 92.42%；Ⅴ：肿瘤 3 cm 100%。

●4. A 55 year old woman has undergone breast conserving surgery for grade 2 DCIS, measuring 1-2 cm.As additional treatment, you would recommend:

一名 55 岁的女性接受了 2 级 DCIS 的保乳手术，肿瘤大小为 1-2 厘米。针对额外治疗，您建议：

A:Surveillance 随访

B:Surveillance and endocrine therapy 随访+内分泌治疗

C:Radiation therapy 放疗

D:Radiation therapy or endocrine therapy 放疗或内分泌治疗

E:Radiation therapy and endocrine therapy 放疗+内分泌治疗

4.1 A genomic signature test for DCIS suggests 'low risk.'

DCIS 的基因检测结果显示复发风险为「低风险」

A.12.31% B.30.77% C.26.15% D. 20% E.10.77%

4.2 A genomic signature test for DCIS suggests 'high risk.'

DCIS 的基因检测结果显示复发风险为「高风险」

A.0% B.0% C.34.85% D.12.12% E.53.03%

●5. Should we endorse genomic signatures for DCIS Management?

在导管原位癌的诊疗管理中，是否应采用基因组学特征作为依据

YES 是：22.7% NO 否：77.3%

▲上下滑动查看▼

筛查与预防（screening and prevention）

●1. Patients receiving taxane-based neo/adjuvant therapy should routinely be offered which of the following for prevention of neuropathy:

患者接受紫杉类药物进行新辅助/辅助化疗时应接受哪种手段预防神经毒性？

A: nothing 不进行预防 30%

B:cooling gloves 冰手套 53%

C:compression gloves 加压手套 17%

1.1 此刻，您是否支持冰手套和/或加压手套以预放紫杉类药物的神经毒性（现场自发投票）？

A:Yes 是 98.5% B.No 否 1.5%

●2. 3 years after breast conserving surgery women with a history of low risk ER+ breast cancer should have screening mammograms how frequently?

保乳手术后 3 年，低风险 ER+ 乳腺癌病史的女性应该多久进行一次乳房 X 光检查？

A: annually 每年 1 次观众投票 75% vs. 专家投票 69.6%

B: every two years 每 2 年 1 次观众投票 24% vs. 专家投票 30.4%

▲上下滑动查看▼

乳房和腋窝手术（Breast and Axillary surgery）

●1. In your clinical practice, of women who are candidates for breast conserving surgery with no contraindications to post-surgical radiation treatment, and do not have pathogenic variants for hereditary cancer risk, what percentage have a mastectomy instead of BCS?

在您的临床实践中，在没有术后放射治疗禁忌证且没有遗传性癌症风险致病变异的保乳手术候选人中，实际接受乳房切除术而不是保乳手术的女性比例是多少？

Ⅰ：＜10% 比例：61.5% ；Ⅱ：20% 比例：15.4%；Ⅲ：30% 比例：10.8%；Ⅳ：40% 比例：9.2%；Ⅴ：50% 比例：0%；Ⅵ：＞50% 比例：3.1%；

●2. A 60 year old woman has been diagnosed with early stage breast cancer. A core biopsy shows grade 2 invasive ductal carcinoma. Axillary exam and axillary ultrasound are negative. Based on clinical exam and imaging, up to what size tumor would you be comfortable omitting sentinel lymph node surgery?

一名 60 岁的女性被诊断出患有早期乳腺癌。粗针穿刺活检显示 2 级浸润性导管癌。腋窝检查和腋窝超声检查均为阴性。根据临床检查和影像学检查，肿瘤大小为多少，您认为可以豁免前哨淋巴结手术？

A:≤1 cm ；B:1.5 cm; C:2 cm; D:2.5 cm; E:3 cm;

F: any cT1 or cT2 lesion 所有的 cT1 或 cT2 病变;

G: Perform SLN surgery regardless of size 无论病灶大小均进行前哨淋巴结手术

2.1 tumor is strongly ER+, PR+,HER2 negative

ER、PR 强阳性，HER2 阴性

A:15.94%; B:5.8%; C: 53.62%; D:1.45%; E: 1.45%; F:4.35%; G:17.39%

2.2 tumor is strongly ER+,PR+,HER2 positive

ER、PR 强阳性，HER2 阳性

A:17.39%; B:1.45%; C: 15.94%; D:1.45%; E: 0%; F: 1.45%; G:62.32%

2.3 tumor is triple-negative

三阴性乳腺癌

A:11.59%; B: 1.45%; C: 2.9%; D:0%; E: 0%; F: 2.9%; G:81.16%

●3. The same criteria for omission of SNB should apply to invasive ductal carcinomas and to invasive lobular carcinomas.

对于浸润性导管癌和浸润性小叶癌，应采用相同的标准豁免 SNB。

A:Agree 同意：40.3%

B: disagree，as we have limited data on ILC 不同意因缺乏浸润性小叶癌数据：59.7%

●4. A patient has been diagnosed with early stage breast cancer, Clinical exam and imaging suggest a tumor above ～1 cm in size.AXilary exam and ultrasound are negative, At what patient age would you be comfortable omiting sentinel lymph node surgery？

患者被诊断为早期乳腺癌，临床检查和成像显示肿瘤直径超过 1 cm。腋窝检查和超声波检查均为淋巴结阴性，当患者年龄为多少时，您会考虑豁免前哨淋巴结手术？

●5. A patient with breast cancer has received neoadjuvant chemotherapy with clinical response, and atthe time of sentinel lymph node surgery, She will receive radiation therapy to the breast. What additional axillary therapy would you recommend?

一名乳腺癌患者接受了新辅助化疗，并且达到临床缓解，在前哨淋巴结手术时，患者将接受乳房放射治疗。你会推荐哪种额外的腋窝治疗？

●6. A patient with ER positive breast cancer (N1) has received neoadjuvant chemotherapy with clinical response, and at the time of sentinel lymph node surgery had macrometastatic residual disease in one of the sentinel lymph nodes. She will receive radiation therapy to the breast. What additional axillary therapy would you recommend for ypN1 disease (3 mm) in 1 of 4 sentinel lymph nodes?

ER 阳性乳腺癌（N1）患者接受了新辅助化疗且达到临床缓解，在前哨淋巴结手术时，其中一个前哨淋巴结含巨大的转移残留病灶。她将接受乳房放射治疗。对于 4 个前哨淋巴结中的 1 个，您建议对 ypN1 病灶（3 mm）进行哪些额外的腋窝治疗？

A: No futher axillary management 无需对淋巴结进一步处理：14%

B:ALND 豁免腋窝淋巴结清扫术：18%

C: Nodal radiation 局部放疗：58%

D:ALND and nodal irradiation 豁免腋窝淋巴结清扫术+淋巴结放疗：9%

●7. A patient with HER 2 positive breast cancer has received neoadjuvant chemotherapy with clinical response, and at the time of sentinellymph node surgery had residual macrometastatic disease in one of the sentinel lymph nodes. She will receive radiation therapy to the breast. What additional axillary therapy would you recommend for ypN1 disease (3 mm) in 1 of 4 sentinel lymph nodes?

HER2 阳性乳腺癌患者接受了新辅助化疗且达到临床缓解，在前哨淋巴结手术时，其中一个前哨淋巴结含巨大的残留转移性病灶。她将接受乳房放射治疗。对于 4 个前哨淋巴结中的 1 个，您建议对 ypN1 病灶（3 mm）进行哪些额外的腋窝治疗？

A: No futher axillary management 无需对淋巴结进一步处理：6%

B:ALND 豁免腋窝淋巴结清扫术：13%

C: Nodal radiation 局部放疗：69%

D:ALND and nodal irradiation 豁免腋窝淋巴结清扫术+淋巴结放疗：12%

▲上下滑动查看▼

放疗（Radiation Therapy）

●1. A 43 year old woman has undergone mastectomy for a grade 3, triple-negative breast cancer. The tumor measures 2.9 cm, and 2 of 3 sentinel lymph nodes are positive. In addition to systemic therapy, what radiation therapy would you recommend?

一名 43 岁女性因 3 级三阴性乳腺癌接受了乳房切除术。肿瘤直径 2.9 厘米，前哨淋巴结 3 枚中有 2 枚阳性。除全身治疗外，您会推荐何种放疗方案？

A: No radiation therapy 不放疗：2.9%

B:Chest wall irradiation only 仅胸壁放疗：2.9%

C: Chest wall and regional nodal irradiation 胸壁+淋巴结放疗：94.1%

●2. A 66 year old woman has undergone mastectomy for a grade 2,ER positive,HER2 negative breast cancer. The tumor measures 1.6 cm, and 1 of 3 sentinel lymph nodes are positive. In addition to systemic therapy, what radiation therapy would you recommend?

一名 66 岁女性因 2 级、ER 阳性且 HER2 阴性乳腺癌，接受了乳房切除术。该肿瘤直径为 1.6 厘米，前哨淋巴结 3 枚中有 1 枚呈阳性。除了全身治疗，您会建议采用哪种放疗方案？

A: No radiation therapy 不放疗：40%

B:Chest wall irradiation only 仅胸壁放疗：10.8%

C: Chest wall and regional nodal irradiation 胸壁+淋巴结放疗：49.2%

●3. A 41 year old women has undergone mastectomy for a grade 2, ER positive, HER2 negative breast cancer. The tumor measures 1.6 cm, 1 of 3 sentinel lymph nodes are positive and the genomic score is low to intermediate risk. In addition to systemic therapy, what radiation therapy would you recommend?

一名 41 岁女性因 2 级、ER 阳性且 HER2 阴性乳腺癌接受了乳房切除术。肿瘤直径 1.6 厘米，前哨淋巴结 3 枚中有 1 枚阳性，基因评分提示低至中风险。除全身治疗外，您会推荐何种放疗方案？

A:No radiation therapy 不放疗：47%

B:Chest wall irradiation only 仅胸壁放疗：6%

C: Chest wall and regional nodal irradiation 胸壁+淋巴结放疗：47%

●4. You are treating a patient who has had mastectomy, implant reconstruction, and axillary lymph node dissection for stage 3 breast cancer, stage T3N1, with metastatic involvement of 2 of 11 axillary lymph nodes. She will receive post-mastectomy radiation therapy including regional nodal irradiation. You would recommend which treatment schedule?

您正在治疗一名因 Ⅲ 期乳腺癌（T3N1 期，11 枚腋窝淋巴结中 2 枚见转移）接受乳房切除术、植入物重建术及腋窝淋巴结清扫术的患者。患者将接受包括区域淋巴结照射在内的乳房切除术后放疗。您会推荐哪种治疗方案？

A:Conventional fractionation with 25 fractions 传统的常规分割（25 次）：23.2%

B:Moderate hypofractionation with 15-16 fractions 中低度分割（15-16 次）：76.8%

●5. You are treating a patient who has had mastectomy, implant reconstruction, and axillary lymph node dissection for stage 3 breast cancer, stage T3N2, with metastatic involvement of 8 of 11 axillary lymph nodes. She will receive post-mastectomy radiation therapy including regional nodal irradiation. You would recommend which treatment schedule?

您正在治疗一名因 Ⅲ 期乳腺癌（T3N2 期，11 枚腋窝淋巴结中 8 枚见转移）接受乳房切除术、植入物重建术及腋窝淋巴结清扫术的患者。患者将接受包括区域淋巴结照射在内的乳房切除术后放疗。您会推荐哪种治疗方案？

A:Conventional fractionation with 25 fractions 传统的常规分割（25 次）：42.1%

B:Moderate hypofractionation with 15-16 fractions 中低度分割（15-16 次）：57.9%

●6. You are treating a patient who has had neoadjuvant chemotherapy, mastectomy, implant reconstruction, and axillary lymph node dissection for stage 3 breast cancer, stageT3N2,with metastatic involvement of 8 of 11 axillary lymph nodes. She will receive post-mastectomy radiation therapy including regional nodal irradiation. You would recommend which treatment schedule?

您正在治疗一名接受过新辅助化疗、乳房切除术、植入物重建术及腋窝淋巴结清扫术的 Ⅲ 期乳腺癌患者，分期为 T3N2（11 枚腋窝淋巴结中 8 枚见转移）。患者将接受包括区域淋巴结照射在内的乳房切除术后放疗。您会推荐哪种治疗方案？

A:Conventional fractionation with 25 fractions 传统的常规分割（25 次）：47.3%

B:Moderate hypofractionation with 15-16 fractions 中低度分割（15-16 次）：52.7%

●7. A 42 year old premenopausal woman has undergone BCS for a stage 1 breast cancer. The tumor is T1c, with negative sentinel lymph nodes, and is grade 2,ER positive>90%, PR positive 70%, and HER2 negative. A genomic risk assay is 'high' and she will receive adjuvant chemotherapy and endocrine therapy. What radiation therapy schedule would you recommend?

一位 42 岁绝经前女性因 I 期乳腺癌接受了保乳手术。肿瘤为 T1c 期，前哨淋巴结阴性，病理分级 2 级，ER 阳性率 > 90%，PR 阳性率 70%，HER2 阴性。基因风险检测提示「高风险」，她将接受辅助化疗和内分泌治疗。您推荐何种放疗方案？

A:No radiation 无放疗：0%

B:Conventional 25 fraction whole breast irradiation 常规 25 次分割全乳照射：3.6%

C:Moderate hypofractionation (i.e.15 or 16 fractions) 中低剂量分割（15-16 次）：70.9%

D:Ultra-hypofractionation (i.e. 5 days of consecutive treatment) 超低剂量分割放疗（即连续 5 天治疗）：21.8%

E:Accelerated partial breast irradiation 加速部分乳腺放疗：3.6%

●8. A 52 year old postmenopausal woman has undergone BCS for a stage 1 breast cancer. The tumor is T1c, with negative sentinel lymph nodes, and was grade 1, ER positive > 95%, PR positive > 95%, and HER2 negative. She will receive adjuvant endocrine therapy. What radiation therapy schedule would you recommend?

一名 52 岁绝经后女性因 I 期乳腺癌接受保乳手术（BCS）。肿瘤为 T1c 期，前哨淋巴结阴性，分级 1 级，ER 阳性率＞95%，PR 阳性率＞95%，HER2 阴性。患者将接受辅助内分泌治疗。您会推荐何种放疗方案？

A:No radiation 无放疗：2%

B:Conventional 25 fraction whole breast irradiation 常规 25 次分割全乳照射：0%

C:Moderate hypofractionation (i.e.15 or 16 fractions) 中低剂量分割（15-16 次）：40%

D:Ultra-hypofractionation (i.e. 5 days of consecutive treatment) 超低剂量分割放疗（即连续 5 天治疗）：43%

E:Partial breast irradiation(5-15 Fx/IORT/Brachytherapy) 部分乳腺照射（5-15 次分割/术中放疗/ IORT /近距离放疗）：16%

●9. A 52 year old postmenopausal woman has undergone BCS for a stage 1 breast cancer. The tumor is T1c, with negative sentinel lymph nodes, and grade 3 and triple negative. She will receive adjuvant chemotherapy. What radiation therapy schedule would you recommend?

一名 52 岁的绝经后女性因 1 期乳腺癌接受保乳手术（BCS）。肿瘤为 T1c 期，前哨淋巴结阴性，3 级，三阴性。患者将接受辅助化疗。您会推荐何种放射治疗计划？

A:No radiation 不放疗：0%

B:Conventional 25 fraction whole breast irradiation 常规 25 次分割全乳照射：9.1%

C:Moderate hypofractionation (i.e.15 or 16 fractions) 中低剂量分割（15-16 次）：63.6%

D:Ultra-hypofractionation (i.e. 5 days of consecutive treatment) 超低剂量分割放疗（即连续 5 天治疗）：25.5%

E:Partial breast irradiation 部分乳腺照射：1.8%

●10. A vigorous 69 year old postmenopausal woman has had BCS for a T1c, node-negative tumor that, was grade 2, strongly ER and PR positive, and HER2 negative. Her mother lived to age 86, and she expects to do the same. She will receive adjuvant endocrine therapy. What radiation therapy schedule would you recommend?

一名 69 岁身体健壮的绝经后女性因 T1c 期、淋巴结阴性乳腺癌接受保乳手术（BCS）。术后肿瘤分级 2 级（中分化），ER 和 PR 强阳性，HER2 阴性。其母亲享年 86 岁，患者预期寿命与之相当。她将接受辅助内分泌治疗。您会推荐何种放疗方案？

A:No radiation 不放疗：1.8%

B:Conventional 25 fraction whole breast irradiation 常规 25 次分割全乳照射：0%

C:Moderate hypofractionation (i.e.15 or 16 fractions) 中低剂量分割（15-16 次）：21.4%

D:Ultra-hypofractionation (i.e. 5 days of consecutive treatment) 超低剂量分割放疗（即连续 5 天治疗）：41.1%

E:Partial breast irradiation 部分乳腺照射：35.7%

●11. For a postmenopausal woman in her 60s who has a T1c cancer with low risk features, and a negative axillary ultrasound. You would recommend which of the following?

对于一名 60 多岁、T1c 期低风险特征乳腺癌且腋窝超声阴性的绝经后女性，您会推荐以下哪种治疗方案？（专家投票 vs. 观众投票）

A:whole breast irradiation 全乳放疗：41% vs. 27%

B:partial breast irradiation 部分乳房放疗：29% vs. 23%

C:sentinel lymph node biopsy, then partial breast irradiation, if negative 前哨淋巴结活检后，若阴性则行部分乳腺放疗：29% vs. 48%

●12. A 70 year old woman has undergone breast conserving surgery for a 1.3 cm, grade 1-2 of 3, and strongly ER positive, PR positive breast cancer, and HER2 0 by IHC. You would recommend:

一名 70 岁女性因肿瘤直径 1.3 cm，分级 1-2 级，免疫组化（IHC）检测 ER、PR 强阳性、 HER2 阴性的乳腺癌接受保乳手术。您会推荐：

A:No further therapy 无需进一步治疗 0%

B:Radiation Therapy 放疗 13.1%

C:Endocrine therapy 内分泌治疗 27.9%

D:Radiation therapy and endocrine therapy 放疗+内分泌治疗 59%

▲上下滑动查看▼

三阴性乳腺癌全身治疗（Systemic therapy:triple-negative breast cancer）

●1. In a patient with a clinically negative axilla, the size threshold for initiating neoadjuvant TCb/AC/pembrolizumab in newly diagnosed TNBC is:

对于临床腋窝阴性的新诊断三阴性乳腺癌（TNBC）患者，启动新辅助化疗方案 TCb/AC/ 帕博利珠单抗方案的肿瘤大小阈值是：

A：1.0 cm：10.1%

B：1.5 cm：11.6%

C：2.0 cm：71%

D：2.5 cm：5.8%

E：3.0 cm：0%

F：＞3 cm：1.4%

●2. A healthy young woman presented with a small breast nodule, and was diagnosed with high-grade, triple negative breast cancer. On MRI and US imaging, the tumor measures 1.7489753 cm in size, and the axilla is clinically negative. Would you recommend neoadjuvant chemotherapy in combination with checkpoint inhibitor immunotherapy?

一名健康年轻女性因发现乳腺小结节就诊，确诊为高级别 TNBC。MRI 和超声检查显示肿瘤大小 1.7489753 cm，腋窝临床阴性。您会推荐新辅助化疗联合免疫检查点抑制剂治疗吗？

A:YES 是 46.3%；B:NO 否 53.7%

●3. You are discussing adjuvant therapy with a patient who has had surgery for a pT1ab pN0 TNBC. You would ordinarily recommend chemotherapy if the tumor was at least how large?

您正在与一名因 pT1ab pN0 TNBC 接受手术的患者讨论辅助治疗。若肿瘤直径超过多少，您通常会建议化疗？

●4. A patient has undergone initial surgery for what was thought to be a stage 1 TNBC. At the time of surgery, she was found to have a 1.1 cm, grade 3 TNBC. What would you recommend as adjuvant therapy?

有一位患者因疑似处于 I 期的 TNBC 接受了初次手术。在手术过程中，发现其为直径 1.1 cm、3 级的 TNBC。对于该患者的辅助治疗，您有什么建议呢？

4.1 metastatic cancer in 1 of 3 sentinel lymph nodes. 3 个前哨淋巴结中有 1 个转移癌

A:AC/T：27.94%

B:TCb/AC：39.71%

C:TCb/AC/pembrolizumab：23.53%

D:TC：5.88%

E:AC/T/avelumab：2.94%

4.2 metastatic cancer in 3 of 5 axillary lymph nodes.5 个腋窝淋巴结中有 3 个转移癌

A:AC/T：19.7%

B:TCb/AC：50%

C:TCb/AC/pembrolizumab：27.27%

D:TC：0%

E:AC/T/avelumab：3.03%

●5. You are discussing adjuvant therapy with a patient who has had surgery for a pT1pN0 TNBC.In deciding between non-anthracycline chemotherapy (e.g. TC)vs taxane- and anthracycline-based chemotherapy, you would recommend anthracycline treatment if the tumor was greater than what size?

您正在与一位因 pT1pN0 三阴性乳腺癌接受过手术的患者讨论辅助治疗方案。在决定是否采用非蒽环类化疗（如 TC 方案）还是紫杉类+蒽环类联合化疗时，若肿瘤大小超过多少，您会推荐蒽环类治疗？

A:0.5 cm：4.5%

B:1.0 cm：43.9%

C:1.5 cm：18.2%

D:2.0 cm：10.6%

E:I would not give anthracyclines for a stage 1 TNBC（I 期均不给予）：22.7%

●6. You are treating a patient with stage2TNBC.She received neoadjuvant TCb/AC/pembrolizumab (a la KN522), well tolerated, and was found at surgery to have a pathological complete response. In routine practice, you would recommend which of the following:

您正在治疗一名 II 期三阴性乳腺癌患者。她接受了新辅助 TCb/AC 方案联合帕博利珠单抗（根据 KEYNOTE-522 试验方案）治疗，耐受性良好，术后病理显示达到完全缓解（pCR）。在常规临床实践中，您会推荐以下哪种方案：

A:Ongoing adjuvant checkpoint inhibition with pembrolizumab 继续使用帕博利珠单抗进行辅助免疫检查点抑制治疗 87.7%

B:No adjuvant checkpoint inhibitor 进行辅助免疫检查点抑制剂治疗 12.3%

●7. You are treating a patient with stage 2 TNBC. She received neoadjuvant TCb/AC/durvalumab (a la GeparNuevo), and was found at surgery to have a pathological complete response. In routine practice, you would recommend which of the following:

您正在治疗一名 II 期三阴性乳腺癌患者。她接受了新辅助 TCb/AC 方案联合度伐利尤单抗（GeparNuevo 试验方案）治疗，术后病理显示达到 pCR。在常规临床实践中，您会推荐以下哪种方案：

A:Ongoing adjuvant checkpoint inhibition with durvalumab 继续使用度伐利尤单抗进行辅助免疫检查点抑制治疗 29.5%

B:Ongoing adjuvant checkpoint inhibition with pembrolizumab 改用帕博利珠单抗进行辅助免疫检查点抑制治疗 8.2%

C:No adjuvant checkpoint inhibitor 不进行辅助免疫检查点抑制剂治疗 62.3%

●8. You are treating a patient with stage II triple-negative breast cancer. She received neoadjuvant TCb/AC regimen combined with pembrolizumab (based on the KEYNOTE-522 trial protocol) and had a good clinical response. However, postoperative examination revealed a residual breast lesion < 1 cm and negative lymph nodes. Which of the following adjuvant treatment regimens would you recommend?

您正在治疗一名 Ⅱ 期三阴性乳腺癌患者。她接受了新辅助 TCb/AC 方案联合帕博利珠单抗（基于 KEYNOTE-522 试验方案）治疗，临床反应良好，但术后发现乳腺残留病灶＜1 cm 且淋巴结阴性。您会推荐以下哪种辅助治疗方案？

A:Ongoing pembrolizumab 继续使用帕博利珠单抗 16.7%

B:Ongoing pembrolizumab and capecitabine 继续使用帕博利珠单抗+卡培他滨 75.8%

C:Capecitabine alone 仅适用卡培他滨 7.6%

●9. You are caring for a patient with stage 2, node-positive TNBC, who has medical contraindications to checkpoint inhibitor therapy. As preferred chemotherapy options, you would recommend which of the following?

您正在治疗一名 II 期、淋巴结阳性的 TNBC 患者，该患者对免疫检查点抑制剂治疗存在医学禁忌。作为首选化疗方案，您会推荐以下哪一种？（专家投票 vs. 观众投票）

A: AC/T（12.9% vs. 21%）

B: TCb/AC（87.1% vs. 79%）

●10. You are caring for a 29 year old woman who presents with a 2.5 cm, triple negative breast cancer and a clinically negative axilla on exam and imaging. She is concerned about future fertility.You recommend consulting with a fertility specialist for possible procedures to preserve fertility options, and initiation of GnRH agonist treatment during chemotherapy. In addition, you would advise the following:

您正在治疗一名 29 岁女性，她被诊断为 2.5 cm 的三阴性乳腺癌，查体和影像学检查显示腋窝临床阴性。她担心影响未来生育能力。您建议她咨询生育专科医生以考虑保留生育功能的可能措施，并在化疗期间启动 GnRH 激动剂治疗。此外，您会给出以下建议：

A:Immunotherapy will not adverselyimpact her future fertility 免疫治疗不会对她未来的生育能力产生不利影响 1.5%

B:The impact of immunotherapy on future fertility is not known but you would favor treatment with pembrolizumab 免疫治疗对未来生育能力的影响尚不明确，但您倾向于使用帕博利珠单抗治疗 83.1%

C:The impact of immunotherapy on future fertility is not known and you would not favor treatment with pembrolizumab given her... 免疫治疗对未来生育能力的影响尚不明确，鉴于她的生育意愿，您不倾向于使用帕博利珠单抗治疗 15.4%

●11. You are treating a patient with stage 2,node-positive TNBC.She additionally has a deleterious BRCA1 or 2 pathogenic variant. She received neoadjuvant TCb/AC/pembrolizumab (ala KN522), and achieved a pathological complete response. Would you recommend adjuvant olaparib?

您正在治疗一名 Ⅱ 期、淋巴结阳性的 TNBC 患者，她还携带 BRCA1 或 2 致病性突变。患者接受了新辅助 TCb/AC/ 帕博利珠单抗治疗（如 KN522 试验方案），并达到了病理完全缓解（pCR）。您会推荐辅助奥拉帕利治疗吗？

A:YES 会 15.2%；B:NO 不会 84.8%

●12. A patient has undergone surgery for a 1.2 cm, grade 3, node-negative, triple negative breast cancer. The pathology report indicates a high percentage of TILs (>50%). The appropriate adjuvant systemic therapy is:

患者已接受手术治疗，肿瘤直径为 1.2 厘米、3 级、淋巴结阴性的三阴性乳腺癌。病理报告显示肿瘤浸润淋巴细胞（TILs）比例较高（> 50%）。以下哪项是合适的辅助系统治疗？

A:None 无需治疗

B:Chemotherapy 化疗

C:Combination immunotherapy with ipilimumab and nivolumab 伊匹木单抗联合纳武利尤单抗的免疫治疗

12.1 若患者 50 岁

A: 9.68%; B: 87.1%; C: 3.23%;

12.2 若患者 68 岁

A: 21.67%; B:76.67 %; C: 1.67%;

●13. A patient has undergone surgery for a 1.2 cm, grade 3, node-negative, triple negative breast cancer. The pathology report indicates a high percentage of TILs (>50%). The appropriate adjuvant systemic therapy is:

患者已接受手术治疗，肿瘤直径为 1.2 厘米、3 级、淋巴结阴性的三阴性乳腺癌。病理报告显示肿瘤浸润淋巴细胞（TILs）比例较高（>50%）。以下哪项是合适的辅助系统治疗？

A:None 无需治疗

B:Chemotherapy 化疗

C:Combination immunotherapy with ipilimumab and nivolumab 伊匹木单抗联合纳武利尤单抗的免疫治疗

12.1 若患者 50 岁

A: 9.68%; B: 87.1%; C: 3.23%;

12.2 若患者 68 岁

A: 21.67%; B:76.67 %; C: 1.67%;

●14. A patient has received neoadjuvant TCb/AC for clinical stage 1TNBC, and achieved a complete pathological response. However, a tumor-specific genomic assay for minimal residual disease drawn after surgery with a blood based, tumor specific genomic era assay is 'positive.' Staging scans are negative. You would recommend:

患者因临床 I 期三阴性乳腺癌接受了新辅助 TCb/AC 方案治疗，并达到了 pCR。然而，术后通过血液肿瘤特异性基因组检测发现微小残留病（MRD）阳性，分期扫描为阴性。您会推荐以下哪种方案？

A:Initiate pembrolizumab 启动帕博利珠单抗 7.9%

B:Initiate pembrolizumab and capecitabine 启动帕博利珠单抗+卡培他滨 4.8%

C:Capecitabine 卡培他滨 23.8%

D:No further therapy 无需进一步治疗 63.5%

▲上下滑动查看▼

HER2 阳性乳腺癌系统治疗（Systemic therapy: HER2 positive breast cancer）

●1. A patient has undergone mastectomy for extensive high-grade DCIS. At the time of surgery she is found to have foci of microinvasive breast cancer that is ER negative and HER23+by IHC.What number of foci of microinvasive cancer would prompt you to recommend adjuvant paclitaxel / trastuzumab therapy?

患者因广泛高级别导管原位癌（DCIS）接受了乳房切除术。术中发现多灶微浸润性乳腺癌，免疫组化（IHC）显示 ER 阴性、HER2 阳性（HER2 3+）。您认为多少个微浸润癌灶会促使您推荐辅助紫杉醇/曲妥珠单抗治疗？

A:1-2：6.3%

B:3-5：26.6%

C:5-9：7.8%

D:10 or more（≥10）：4.7%

E:I would not recommend paclitaxel/trastuzumab for microinvasion（多灶微浸润性乳腺癌任何情况都不推荐）：54.7%

●2. In a patient with T1abN0, HER2 positive breast cancer, the size threshold for recommending paclitaxel/ trastuzumab therapy is:

对于 T1abN0、HER2 阳性乳腺癌患者，推荐紫杉醇/曲妥珠单抗治疗的肿瘤大小阈值是：

A:>0.3 cm：4.69%

B:>0.4 cm：20.31%

C:>0.5 cm：89.06%

D:>0.7 cm：90.63%

E:>0.9 cm：92.19%

F:>1.0 cm：100%

●3.In a patient with a clinically negative axilla, the tumor size of the primary tumor that would make neoadjuvant chemotherapy + anti-HER2 therapy preferable to adjuvant treatment is:

对于临床腋窝阴性患者，使新辅助化疗+抗 HER2 治疗优于辅助治疗的原发肿瘤大小阈值是：

A:>1.0 cm：18.84%

B:>1.5 cm：39.13%

C:>2.0 cm：91.30%

D:>2.5 cm：95.65%

E:>3 cm：100%

●4. A patient has a newly diagnosed breast cancer that is ER positive and HER2 positive, and measures slightly greater than 2 cm in size. The axilla is clinically negative by exam and imaging.As neoadjuvant therapy, you would recommend:

一名新诊断为 ER 阳性、HER2 阳性乳腺癌患者，肿瘤直径略大于 2 cm，临床及影像学检查提示腋窝阴性。作为新辅助治疗，您会推荐：

A:TH: 4.8%

B:TH + Pertuzumab: 34.9%

C:TCbH: 11.1%

D:TCbH + Pertuzumab: 49.2%

●5. A patient has a newly diagnosed breast cancer that is ER positive and HER2 positive. She undergoes surgery, with final pathology showing a 2.4 cm tumor, with negative lymph nodes. As adjuvant chemotherapy including HER2-blockade, you would recommend:

一名新诊断为 ER 阳性、HER2 阳性乳腺癌患者接受手术，最终病理显示肿瘤直径 2.4 cm，淋巴结阴性。作为包含 HER2 阻断的辅助化疗方案，您会推荐：

A:TH: 32.8%

B:TH + Pertuzumab:9.8%

C:TCbH: 39.3%

D:TCbH + Pertuzumab: 18%

●6. A patient received neoadjuvant TCbHP for stage 2, node-positive, ER negative, HER2 positive (3+and FISH positive) breast cancer. At surgery, she is found to have residual tumor in the breast and lymph nodes. Repeat HER2 testing indicates that the tumor is HER2 2+ by IHC. As adjuvant treatment, you would recommend:

一名 II 期、淋巴结阳性、ER 阴性、HER2 阳性（免疫组化 3 + 且 FISH 阳性）乳腺癌患者接受了新辅助 TCbHP 治疗。术后发现乳腺和淋巴结存在残留肿瘤，重复 HER2 检测显示免疫组化 HER2 为 2+。作为辅助治疗，您会推荐：

A:No further systemic therapy 不再进行全身治疗 0%

B:Adjuvant AC chemotherapy 辅助 AC 化疗方案 7.8%

C:Trastuzumab emtansine 恩美曲妥珠单抗 85.9%

D:Trastuzumab deruxtecan 德曲妥珠单抗 6.3%

●7. A patient received neoadjuvant TCHP for stage 2,node-positive, ER negative, HER2 positive (3+) breast cancer. At surgery, she is found to have residual tumor in the breast and lymph nodes. Repeat HER2 testing indicates that the tumor is HER2 2+ by lHC, and negative by FISH(HER2/neu copy number, 3.9, ratio 1.9). As adjuvant treatment, you would recommend:

一名 II 期、淋巴结阳性、ER 阴性、HER2 阳性（3+）乳腺癌患者接受了新辅助 TCH 治疗。术后发现乳腺和淋巴结存在残留肿瘤，重复 HER2 检测显示免疫组化（IHC）为 2+，荧光原位杂交（FISH）阴性（HER2/neu 拷贝数 3.9，比值 1.9）。作为辅助治疗，您会推荐：

A:No further systemic therapy 不再进行全身治疗 3.2%

B:Adjuvant AC or EC chemotherapy 辅助 AC/EC 化疗方案 17.5%

C:Trastuzumab emtansine 恩美曲妥珠单抗 71.4%

D:Trastuzumab deruxtecan 德曲妥珠单抗 7.9%

●8. A patient has a 3 cm estrogen receptor negative HER2+ breast cancer. The HER2DX test shows low risk and high pCR score. You would recommend:

一名肿瘤直径 3 cm 雌激素受体阴性、HER2 阳性乳腺癌患者，HER2DX 检测显示低复发风险和高病理完全缓解（pCR）评分。您会推荐：

A:Surgery, then adjuvant paclitaxel/trastuzumab 手术，然后辅助紫杉醇/曲妥珠单抗 5%

B: Neoadjuvant paclitaxel/trastuzumab 新辅助紫杉醇/曲妥珠单抗 5%

C: Neoadjuvant THP 新辅助 THP 15%

D: Neoadjuvant TCbHP 新辅助 TCbHP 26%

E:Would not have used HER2DX 不会使用 HER2DX 50%

●9. In routine treatment of stage 2 or 3, HER2 positive breast cancer, the preferred regimen is

对 2 期或 3 期 HER2 阳性乳腺癌的常规治疗中，首选方案是：（专家投票 vs. 观众投票）

A:TCbHP （74% vs. 54%）

B: TCbHP and then AC 即 TCbHP → AC （21% vs. 23%）

C: TCbHP and then AC with HP 即 TCbHP →AC/ HP （5% vs. 21%）

●10. As neoadjuvant therapy for an ER negative,HER2 positive case of inflammatory breast cancer, the preferred treatment regimen is:

对于雌激素受体（ER）阴性、HER2 阳性的炎性乳腺癌患者，作为新辅助治疗，首选方案是：

A:TCbHP：60.3%

B:TCbHP followed by anthracyclines with or without HP 即 TCbHP → 蒽环化疗 ±HP：39.7%

▲上下滑动查看▼

ER 阳性/HER2 阴性乳腺癌全身治疗（Systemic therapy:ER positive, HER2 negative breast cancers）

●1. You would in general recommend chemotherapy if the likely benefit on distant-recurrence free survival is:

通常，如果化疗对无远处复发生存率的可能获益达到以下哪项，您会推荐化疗？（专家投票 vs. 观众投票）

A.10% or more（≥10%）（21% vs. 20%）

B.5% or more（≥5%）（21% vs. 65%）

C.3% or more（≥3%）（21% vs. 13%）

D.1% or more（≥1%）（21% vs. 0%）

●2. Based on historical outcomes of studies such as NSABP B-21 for tumors 1 cm or smaller, node- negative, ER positive, and HER2 negative, the risk of distant metastatic recurrence with endocrine therapy is sufficiently low that genomic risk assays are unnecessary.

基于 NSABP B-21 等研究的历史结果，对于肿瘤 ≤1 cm、淋巴结阴性、ER 阳性且 HER2 阴性的患者，接受内分泌治疗后的远处转移复发风险足够低，因此无需进行基因组风险检测。

A:True 是 61.9% B:False 否 38.1%

●3.The size threshold for ordering genomic assays in ER+ node-negative cancers to decide on chemotherapy is：

在 ER+淋巴结阴性癌症中进行基因组测定以决定化疗的肿瘤大小是：

●4. Ki67 or similar proliferation assays performed by a high-quality pathology lab can define low/intermediate risk inHR+ cancers with comparable accuracy as multigenomic assays.

由高质量病理实验室进行的 Ki67 或类似增殖检测，在 HR + 肿瘤中定义低/中风险的准确性与多基因检测相当。

A：True 是 47.6% B：False 否 52.4%

●5. A 50 year old woman is discussing treatment options for a 3-4 cm, clinically node- negative breast cancer with grade 3 features.The tumor is ER low-positive (5%), PR <1%, and HER2 negative by IHC. Repeat ER testing confirms the result. As neoadjuvant therapy, you would recommend:

一名 50 岁女性正在讨论治疗方案，其乳腺癌特征为肿瘤直径 3-4 cm、临床淋巴结阴性、组织学 3 级。肿瘤 ER 低表达（5%），PR<1%，免疫组化检测 HER2 阴性。重复 ER 检测确认结果。作为新辅助治疗，您会推荐：（专家投票 vs. 观众投票）
A: AC/T （17% vs. 24%）
B:TC （2% vs. 3%）
C: Pembrolizumab with concurrent taxane then AC chemotherapy 帕博利珠单抗联合紫杉类化疗 →AC 化疗（82% vs. 72%）

●6. A 63 year old woman presents with clinical T3N1 breast cancer that is grade 1, has ductal and lobular histology, and is strongly ER positive and PR positive. As her next treatment, you would recommend:

一名 63 岁女性，临床诊断为 T3N1 期乳腺癌，组织学分级 1 级，导管和小叶混合癌，ER 和 PR 均为强阳性。您建议下一步治疗为：

A:Neoadjuvant chemotherapy 新辅助化疗 12.5%

B:Neoadjuvant endocrine therapy 新辅助内分泌治疗 18.8%

C:Order genomic signature 基因检测 23.4%

D:Neoadjuvant endocrine therapy and CDK46 inhibitor 新辅助内分泌治疗联合 CDK4/6 抑制剂 7.8%

E:Proceed to mastectomy as systemic treatment is unlikely to affect surgical options 直接行乳房切除术，因系统治疗可能不影响手术选择 37.5%

●7. A 63 year old woman presents with clinical T3N1 breast cancer that is grade 1, has ductal and lobular histology, and is strongly ER positive and PR positive. Agenomic assay confirms a low risk signature. As her next treatment, you would recommend:

一名 63 岁女性，临床诊断为 T3N1 期乳腺癌，组织学分级 1 级，导管和小叶混合癌，ER 和 PR 均为强阳性。基因组检测确认其为低风险特征。您建议下一步治疗为：

A:Neoadjuvant chemotherapy 新辅助化疗 4.7%

B:Neoadjuvant endocrine therapy 新辅助内分泌治疗 31.1%

C:Neoadjuvant endocrine therapy and CDK46 inhibitor 新辅助内分泌治疗联合 CDK4/6 抑制剂 9.4%

D:Proceed to mastectomy as systemic treatment is unlikely to affect surgical options 直接行乳房切除术，因系统治疗可能不影响手术选择 54.7%

●8. A 63 year old woman presents with clinical T3N1 breast cancer that is grade 1, has ductal and lobular histology, and is strongly ER positive and PR positive with a low risk genomic score. She receives 6 months of neoadjuvant endocrine treatment with substantial clinical response. Following surgery she is found to have residual tumor in the breast cancer and in 3 of 11 axillary lymph nodes. In addition to optimal endocrine therapy, would you now recommend adjuvant chemotherapy?

一名 63 岁女性，临床诊断为 T3N1 期乳腺癌，组织学分级 1 级，导管和小叶混合癌，ER 和 PR 均为强阳性，基因组评分低风险。她接受了 6 个月的新辅助内分泌治疗，临床反应显著。术后发现乳腺和 11 枚腋窝淋巴结中的 3 枚存在残留肿瘤。除了最佳内分泌治疗外，您是否建议辅助化疗？（专家投票 vs. 观众投票）

A.YES 是（50% vs. 71%） B.NO 否（50% vs. 28%）

●9. A 63 year old woman has undergone surgery for a 3 cm, grade 1,multifocal lobular breast cancer,tive affecting 6 of 13 axillary lymph nodes.The tumor is ER positive >95%,PR positive >95%, and HER2 0 by IHC.An OncotypeDX recurrence score is 11.You would recommend:

一名 63 岁女性因肿瘤直径 3 cm、1 级、多灶性小叶乳腺癌接受手术，13 枚腋窝淋巴结中有 6 枚转移。肿瘤免疫组化显示 ER 阳性率＞95%、PR 阳性率＞95%，HER2 评分为 0。Oncotype DX 复发评分为 11。您会推荐：

A:Endocrine therapy alone 单纯内分泌治疗 1.6%

B:Chemotherapy then ET 化疗后内分泌治疗 4.8%

C:Endocrine therapy plus a CDK4/6 inhibitor 内分泌治疗联合 CDK4/6 抑制剂 41.3%

D:Chemotherapy, then ETand CDK4/6 inhibitor 化疗后内分泌治疗联合 CDK4/6 抑制剂 52.4%

●10. A 49 year old woman has been diagnosed with an ER positive, HER2 negative breast cancer.Germline genetic testing discloses aPALB2 pathological variant. Her clinical stage meets the eligibility criteria of the OLYMPIA study.In addition to standard chemotherapy and/or endocrine therapy as indicated, would you recommend adjuvant olaparib?

一名 49 岁女性被诊断为雌激素受体（ER）阳性、人表皮生长因子受体 2（HER2）阴性乳腺癌。胚系基因检测显示 PALB2 基因致病性变异。其临床分期符合 OLYMPIA 研究的入选标准。除标准化疗和 / 或内分泌治疗（如适用）外，是否推荐辅助奥拉帕利治疗？

A.YES 是 68.3% B.NO 否 31.7%

●11. The recommended duration of endocrine therapy for a patient with aHER2 negative breast cancer of 1.8 cm, grade 2 is:

对于以下 HER2 阴性乳腺癌患者，推荐的内分泌治疗持续时间为：

A: 5 年 B:7-8 年 C:10 年

11.1 ER positive, with 1 of 4 sentinel lymph nodes positive 肿瘤大小 1.8 cm、2 级、ER 阳性，前哨淋巴结 4 枚中有 1 枚阳性

A: 12.5%; B: 73.44%; C: 14.06%;

11.2 node-negative ER positive, with an OncotypeDX recurrence score of 28(or MammaPrint 『high' score) 淋巴结阴性、ER 阳性，OncotypeDX 复发评分为 28（或 MammaPrint「高风险」评分）

A: 37.5%; B: 45.31%; C: 17.19%;

11.3 ER positive, with 3 of 8 axillary lymph nodes positive 肿瘤大小 1.8 cm、2 级、ER 阳性，腋窝淋巴结 8 枚中有 3 枚阳性

A: 1.59%; B: 46.03%; C: 52.38%;

●12. A postmenopausal woman has been diagnosed with aT2N0 ER positive,PR positive,HER2 negative breast cancer, measuring 2.4 cm, grade 2, and is node-negative. Genomic testing indicates an OncotypeDX recurrence score of 28 (or MammaPrint High 1) result. As adjuvant chemotherapy, you would recommend:

一位绝经后女性被诊断为 T2N0 期 ER 阳性、PR 阳性、HER2 阴性乳腺癌，肿瘤直径 2.4 cm，2 级，淋巴结阴性。基因检测显示 OncotypeDX 复发评分为 28（或 MammaPrint 高风险 1 级）。作为辅助化疗，您会推荐：

A:AC/T 27.1%

B:TC 72.9%

●13. A postmenopausal woman has been diagnosed with a T2N1 ER positive, PR positive,HER2 negative breast cancer, measuring 2.4 cm, grade 2,with 2 of 3 sentinel lymph nodes positive. Genomic testing indicates an OncotypeDX recurrence score of 28 (or MammaPrint High 1) result. As adjuvant chemotherapy, you would recommend:

一位绝经后女性被诊断为 T2N1 期 ER 阳性、PR 阳性、HER2 阴性乳腺癌，肿瘤直径 2.4 cm，2 级，前哨淋巴结 2/3 阳性。基因检测显示 OncotypeDX 复发评分为 28（或 MammaPrint 高风险 1 级）。作为辅助化疗，您会推荐：

A:AC/T 85%

B:TC 15%

●14. A postmenopausal woman has been diagnosed with a T2N1 ER positive, PR positive,HER2 negative breast cancer, measuring 2.4 cm, grade 2,with 2 of 3 sentinel lymph nodes positive. Genomic testing indicates an OncotypeDX recurrence score of 28 (or MammaPrint High 1) result. As adjuvant chemotherapy, you would recommend:

A:AC/T 71.7%

B:TC 28.3%

●15. A postmenopausal woman has been diagnosed with a T2N0 ER positive,PR positive,HER2 negative breast cancer, measuring 1.8 cm, grade 3. Genomic testing indicates an OncotypeDX recurrence score of 32 (or MammaPrint High 2) result. As adjuvant chemotherapy, you would recommend:

一位绝经后女性被诊断为 T2N0 期 ER 阳性、PR 阳性、HER2 阴性乳腺癌，肿瘤直径 1.8 cm，3 级。基因检测显示 OncotypeDX 复发评分为 32（或 MammaPrint 高风险 2 级）。作为辅助化疗，您会推荐：

A:AC/T 66.1%

B:TC 33.9%

●16. In a 60 year old postmenopausal woman with a T1cN1 ER+PR+HER2-Breast Cancer affecting 3 of 11 Lymph Nodes, and a Oncotype Score of 13. In addition to adjuvant endocrine treatments, you would recommend:

一位 60 岁的绝经后女性被诊断为 T1cN1 期 ER+/PR+/HER2 -乳腺癌，11 枚淋巴结中 3 枚受累，OncotypeDX 复发评分为 13。除辅助内分泌治疗外，您会推荐：

A:No chemotherapy 不化疗 71%

B: TC chemotherapy TC 化疗 15%

C: AC/T chemotherapy AC/T 化疗 14%

●17. ln a 60 year old postmenopausal woman with a T1cN2ER+PR+HER2-Breast Cancer affecting 4 of 11 Lymph Nodes, and a Oncotype Score of 13. In addition to adjuvant endocrine treatments, you would recommend:

一位 60 岁的绝经后女性被诊断为 T1cN2 期 ER+PR+HER2 - 乳腺癌，11 枚淋巴结中 4 枚受累，OncotypeDX 复发评分为 13。除辅助内分泌治疗外，您会推荐：

A:No chemotherapy 不化疗 34%

B: TC chemotherapy TC 化疗 31%

C: AC/T chemotherapy AC/T 化疗 34%

●18. A premenopausal 42 year old woman has been diagnosed with an ER positive,HER2 negative 1.4 cm, grade 2, node-negative breast cancer. As adjuvant therapy, you would recommend:

一位 42 岁的绝经前女性被诊断为 ER 阳性、HER2 阴性、肿瘤直径 1.4 cm、分级 2 级、淋巴结阴性的乳腺癌。作为辅助治疗，您会推荐：

A.Tamoxifen（他莫昔芬）；B.OFS + tamoxifen（他莫昔芬）; C.OFS +AI；D.Chemotherapy followed by endocrine therapy（化疗序贯内分泌治疗）

18.1：OncotypeDX score is 12（DX 评分 12 分）：

A.63.93 %；B.18.03%；C.14.75%；D.3.28%

18.2：OncotypeDX score is 18（DX 评分 18 分）：

A.24.19 %；B.27.42%；C.32.26%；D.16.13%

18.3：OncotypeDX score is 23（DX 评分 23 分）：

A.11.29 %；B.11.29%；C.20.97%；D.56.45%

●19. A premenopausal 42 year old woman has been diagnosed with a 1.4 cm, grade 2, with one positive axillary lymph node. As adjuvant therapy, you would recommend:

一位 42 岁处于绝经前的女性，被确诊患上了肿瘤直径为 1.4 cm、分级 2 级且伴有一个腋窝淋巴结呈阳性的乳腺癌。针对其辅助治疗，您会给出怎样的建议：

A.Tamoxifen（他莫昔芬）；B.OFS + tamoxifen（他莫昔芬）; C.OFS +AI；D.Chemotherapy followed by endocrine therapy（化疗序贯内分泌治疗）

19.1：OncotypeDX score is 12（DX 评分 12 分）：

A.1.64 %；B.19.67%；C.39.34%；D.39.34%

19.2：OncotypeDX score is 18（DX 评分 18 分）：

A.0 %；B.9.84%；C.22.95%；D.67.21%

19.3：OncotypeDX score is 23（DX 评分 23 分）：

A.0 %；B.8.2%；C.9.84%；D.81.97%

▲上下滑动查看▼

幸存者（Survivorship）

●1. Breast cancer patients should routinely be asked about sexual health in regular follow ups

在定期随访中应询问乳腺癌患者的性健康情况

A: 同意：91.3%

B: 不同意：6.9%

●2. The appropriate duration of follow-up by a cancer specialist for women with early stage breast cancer is

肿瘤医师对早期乳腺癌患者最佳随访时间为（专家投票 VS. 观众投票）

A:1 年：2% VS. 3%

B:3 年：3% VS. 3%

C:5 年：39% VS. 37%

D:10 年：29% VS. 24%

E: 不确定：27% VS. 30%

●3. A 76 year old woman has been diagnosed with a 1 cm breast cancer that is grade 2, and ER positive, PR positive, and HER2 negative.Her axilla is negative on ultrasound imaging and she will not require sentinel lymph node surgery. She would prefer to avoid surgery if reasonable for her long term cancer outcomes.

一名 76 岁女性被诊断为 1 厘米、2 级乳腺癌，雌激素受体（ER）阳性、孕激素受体（PR）阳性，人表皮生长因子受体 2（HER2）阴性。其腋窝超声检查结果为阴性，无需接受前哨淋巴结手术。若从以下哪些长期癌症预后的合理性因素考量，她倾向于避免手术？

A:Neoadjuvant endocrine therapy with an Al and reassessment surgical options in 6 months

新辅助内分泌治疗（使用芳香化酶抑制剂）+ 6 个月后重新评估手术选择：53.7%

B:Stereotactic radiation therapy 立体定向放射治疗：6.0%

C:Upfront surgery 立即手术：22.4%

D:Cryo- or radiofrequency ablation therapy to the breast tumor 乳腺肿瘤冷冻或射频消融治疗：17.9%

▲上下滑动查看▼

乳腺癌局部复发的治疗(Treatment of Local-Regional Recurrence of Breast Cancer)

注：In this section, please assume that all patients have undergone staging scans, without evidence of stage IV disease

在本节中，请假设所有患者都接受了分期扫描，没有 IV 期疾病的证据

●1. A patient has undergone breast conserving surgery, adjuvant AC/T chemotherapy,and radiation therapy for a T1cN0 triple negative breast cancer. Three years later, she has a local recurrence in the breast, with similar histology, measuring～1.5 cm. You would recommend:

一名 T1cN0 三阴性乳腺癌患者已接受保乳手术、辅助 AC/T 方案化疗及放射治疗。三年后，其乳房出现局部复发，组织学特征相似，肿瘤直径约 1.5 cm。您会推荐以下哪种治疗方案？

A:Mastectomy 乳房切除术 8.7%

B:Lumpectomy with re-irradiation 肿块切除术联合再次放疗 4.3%

C:Mastectomy followed by adjuvant TCb Chemotherapy 乳房切除术后序贯辅助 TCb 方案化疗 37.7%

D:Neoadjuvant TCb chemotherapy 新辅助 TCb 方案化疗 21.7%

E:Neoadjuvant TCb chemotherapy and pembrolizumab 新辅助 TCb 方案化疗联合帕博利珠单抗 27.5%

●2. A patient with a history of stage2,ER positive,PR positive,HER2 negative breast cancer was treated with breast conserving surgery, radiation therapy, and adjuvant Al.Six years after initial treatment, and while on Al therapy, she had local recurrence in the breast. The tumor is ER positive, PR low, HER2 negative, and grade 2. Do you believe genomic risk signature testing is informative for the benefits of chemotherapy in women who have had local- regional tumor recurrence on adjuvant endocrine therapy?

一名既往患有 ER 阳性、PR 阳性、HER2 阴性的 II 期乳腺癌患者，接受了保乳手术、放疗及辅助芳香化酶抑制剂（AI）治疗。初始治疗 6 年后，在 AI 治疗期间出现乳房局部复发。复发肿瘤 ER 阳性、PR 低表达、HER2 阴性，分级为 2 级。您认为，对于在辅助内分泌治疗期间出现局部区域肿瘤复发的女性，基因组风险特征检测是否有助于判断化疗的获益？

A：是：29.9% B: 不是：70.1%

●3. A patient with a history of stage 2, ER positive, PR positive, HER2negative breast cancer was treated with breast conserving surgery, radiation therapy, and adjuvant AI. Six years after initial treatment, and while on Al therapy, she had local recurrence in the breast. In addition to mastectomy, you would recommend the following as endocrine treatment:

一名既往患有 II 期、ER 阳性、PR 阳性、HER2 阴性乳腺癌的患者，接受了保乳手术、放疗及辅助芳香化酶抑制剂（AI）治疗。初始治疗 6 年后，在 AI 治疗期间出现乳房局部复发。除乳房切除术外，您会推荐以下哪种内分泌治疗方案？

A:Fulvestrant 氟维司群：18.5%

B:Tamoxifen 他莫昔芬：52.3%

C:Fulvestrant plus a CDK46 inhibitor 氟维司群+CDK4/6 抑制剂：29.2%

●4. A postmenopausal woman was treated with breast conserving surgery, whole breast radiation therapy, and adjuvant endocrine therapy for a T2N0 ER positive,PR positive,HER2 negative breast cancer. She now has a local recurrence in the ipsilateral breast. The duration of time since original diagnosis that would possibly enable retreatment with lumpectomy and partial breast irradiation is:

有一位绝经后的女性，曾被诊断出患有 T2N0 期、ER 阳性、PR 阳性且 HER2 阴性的乳腺癌。她当时接受了保乳手术、全乳放射治疗以及辅助内分泌治疗。如今，她的同侧乳房出现了局部复发情况。那么，从最初确诊到现在的时长，若要考虑再次进行肿块切除手术并实施部分乳房照射治疗，这个时长应该是：

A:3 年：25%

B:5 年：75%

C:7 年：85%

D:10 年：100%

●5. In general for a patient with very limited metastatic disease and highly effective treatment options and/or good initial response to therapy one should strongly consider definitive local regional treatment.

总体而言，对于转移性疾病程度极低、拥有高效治疗方案，和（或）对治疗初期反应良好的患者，应着重考虑开展根治性局部区域治疗。（专家投票 vs. 观众投票）

A: 同意：87.1% VS. 93%

B: 不同意：12.9% VS. 6%

▲上下滑动查看▼

乳腺癌寡转移（Oligometastatic breast cancer）

●1. A patient with de novo oligometastatic disease with a single bone metastasis in the sternum and a clinically negative axilla is undergoing curative treatment for primary breast cancer. What axillary management would you recommend?

有一位初发寡转移疾病患者，其胸骨处存在单个骨转移病灶，且腋窝在临床上呈阴性，目前正在接受原发性乳腺癌的根治性治疗。针对该患者的腋窝处理，您会给出怎样的建议呢？

A:No axillary treatment 不进行腋窝处理 21.2%

B:Axillary radiation 腋窝放疗 1.5%

C:Sentinel lymph node surgery 前哨淋巴结手术 71.2%

D:Axillary dissection 前哨淋巴结手术 6.1%

●2. A 47 year old woman has been diagnosed with oligometastatic breast cancer.She presented with a T2N1 tumor that was ER negative and HER2 positive. Staging scans showed an isolated lesion in the iliac crest, which was biopsied and shown to be metastatic carcinoma. She received induction TCbHP therapy with a good clinical response. Repeat imaging studies show resolution of tumor in lymph node, small residual tumor in the breast, and sclerosis of the only known bone lesion. You would recommend which of the following:

一名 47 岁女性被诊断为寡转移性乳腺癌，其原发肿瘤为 T2N1 期、ER 阴性、HER2 阳性。分期扫描显示髂嵴有一个孤立性病变，活检证实为转移性癌。她接受了诱导 TCbHP 方案治疗，临床反应良好。复查影像学显示：淋巴结肿瘤消失，乳房残留小病灶，已知骨转移灶出现硬化。您会推荐以下哪种治疗方案？

A:Breast and axillary surgery; maintenance HP 乳房和腋窝手术；维持 HP 治疗 8.8%

B:Breast and axillary surgery; post surgical radiation therapy as indicated; maintenance HP 乳房和腋窝手术；术后根据指征行放疗；维持 HP 治疗 76.5%

C:Maintenance HP, only 仅维持 HP 治疗 14.7%

●3. A 47 year old woman has been diagnosed with oligometastatic breast cancer.She presented with a T2N1 tumor that was ER negative and HER2 positive.Staging scans including brain imaging owing to a headache, showed an isolated lesion right parietal lobe with mild surrounding edema. She underwent resection of the CNS lesion and stereotactic radiotherapy, and then received trastuzumab deruxtecan with a good clinical response in the breast and axilla. You would recommend which of the following:

一名 47 岁女性被诊断为寡转移性乳腺癌，其原发肿瘤为 T2N1 期、ER 阴性、HER2 阳性。因头痛行分期扫描（包括脑成像）显示右侧顶叶孤立性病变伴轻度周围水肿。她接受了中枢神经系统（CNS）病变切除术和立体定向放疗，随后使用德曲妥珠单抗（T-DXd）治疗，乳房和腋窝病灶临床反应良好。您会推荐以下哪种治疗方案？

A:Breast and axillary surgery; maintenance trastuzumab deruxtecan 乳房和腋窝手术；维持 T-DXd 治疗 4.4%

B:Breast and axillary surgery; post surgical radiation therapy to the breast as indicated; maintenance trastuzumab deruxtecan 乳房和腋窝手术；术后根据指征行乳房放疗；维持 T-DXd 治疗 29.4%

C:Maintenance trastuzumab deruxtecan, only 仅维持 T-DXd 治疗 51.5%

D:Breast and axillary surgery and radiation; switch systemic treatment to TCbHP with 'curative' intent 乳房和腋窝手术及放疗；转换系统治疗为 TCbHP 方案（以「治愈」为目的）14.7%

●4. A 53 year old woman has been diagnosed with T3Nx triple negative breast cancer.Staging scans identify an isolated liver lesion, which is biopsied and shown to be metastatic cancer.Testing of the breast primary is PDL1 negative. She receives induction TCb/AC chemotherapy with concurrent pembrolizumab, and has a substantial clinical response.Repeat imaging shows resolution of the liver lesion. She undergoes mastectomy and sentinel lymph node surgery showing residual 1.3 cm of grade 3 TNBC in the breast. You would recommend:

一名 53 岁女性被诊断为 T3Nx 三阴性乳腺癌（TNBC）。分期扫描发现孤立性肝转移灶，活检证实为转移性癌, 原发灶 PD-L1 检测阴性。她接受了 TCb/AC 化疗联合帕博利珠单抗诱导治疗，临床反应显著。复查影像显示肝转移灶消失。随后行乳房切除术及前哨淋巴结活检，术后病理提示乳房残留 1.3 cm 的 3 级 TNBC。您会推荐以下哪种治疗方案？

A:Ongoing pembrolizumab 继续帕博利珠单抗治疗 29%

B:Ongoing pembrolizumab and radiation therapy 继续帕博利珠单抗联合放疗 25.8%

C:Ongoing pembrolizumab,radiation therapy, and capecitabine 继续帕博利珠单抗、放疗及卡培他滨治疗 45.2%

D:Observation 观察随访 0%

●5. A 63 year old woman has been diagnosed with ER positive, PR positive,HER2 negative breast cancer. She undergoes breast conserving surgery and sentinel lymph node surgery. She has 2.8 cm of grade 2 cancer in the breast, with 3 of 3 axillary lymph nodes positive for metastatic breast cancer.An OncotypeDX recurrence score is sent, and is 28.Staging scans show two areas suspicious for metastatic disease, one in the lumbar spine, and another in a rib. The vertebral body lesion is biopsied, and positive for metastatic carcinoma. You would recommend the following:

一名 63 岁女性被诊断为 ER 阳性、PR 阳性、HER2 阴性乳腺癌。她接受了保乳手术和前哨淋巴结活检，术后病理显示乳房肿瘤大小 2.8 cm、2 级，腋窝淋巴结 3/3 转移。OncotypeDX 复发评分为 28 分。分期扫描显示腰椎和肋骨两处可疑转移灶，椎体病灶活检证实为转移性癌。您会推荐以下哪种治疗方案？

A:Initiate of Al and CDK46i for metastatic breast cancer AI 联合 CDK4/6 抑制剂治疗转移性乳腺癌 75.4%

B:Adjuvant chemotherapy followed by Al and CDK46i 辅助化疗后序贯 AI 和 CDK4/6 抑制剂 3.3%

C:Adjuvant chemotherapy followed by radiation therapy to the breast and regional nodes as indicated, followed by Al and CDK46i 辅助化疗后根据指征行乳房及区域淋巴结放疗，再序贯 AI 和 CDK4/6 抑制剂 21.3%

●6. A patient with de novo oligometastatic disease with a single bone metastasis in the sternum and a clinically negative axilla is undergoing treatment with curative intent. What axillary management would you recommend?

一名初诊时即发现胸骨单一骨转移且临床腋窝阴性的寡转移乳腺癌患者，正接受根治性治疗。您会推荐以下哪种腋窝处理方案？

A:No axillary treatment 不处理腋窝 21.7%

B:Axillary radiation 腋窝放疗 8.7%

C:Sentinel lymph node surgery 前哨淋巴结活检 68.1%

D:Axillary dissection 腋窝淋巴结清扫 1.4%

●7. In general for a patient with very limited metastatic disease and highly effective treatment options and/or good initial response to therapy one should strongly consider definitive local regional treatment.

A: 同意：87.1% vs. 93%

B: 不同意：12.9% vs. 6%

▲上下滑动查看▼

整理：毛阳；编辑：Bree

题图：站酷海洛

投稿：sunjiamei@dxy.cn

免责声明：本内容来自腾讯平台创作者，不代表腾讯新闻或腾讯网的观点和立场。