乳腺癌寡转移诊疗临床实践指南(2026版)

中华医学会外科学分会乳腺外科学组

中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (4) : 407-412.

PDF(1342 KB)
PDF(1342 KB)
中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (4) : 407-412. DOI: 10.19538/j.cjps.issn1005-2208.2026.04.03
指南与共识

乳腺癌寡转移诊疗临床实践指南(2026版)

作者信息 +

Clinical practice guideline for the diagnosis and treatment of breast cancer oligometastasis (2026 edition)

Author information +
文章历史 +

引用本文

导出引用
中华医学会外科学分会乳腺外科学组. 乳腺癌寡转移诊疗临床实践指南(2026版)[J]. 中国实用外科杂志. 2026, 46(4): 407-412 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.04.03
Chinese Society of Breast Surgery,Chinese Society of Surgery,Chinese Medical Association. Clinical practice guideline for the diagnosis and treatment of breast cancer oligometastasis (2026 edition)[J]. Chinese Journal of Practical Surgery. 2026, 46(4): 407-412 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.04.03
中图分类号: R6   

参考文献

[1]
Hellman S, Weichselbaum RR. Oligometastases[J]. J Clin Oncol, 1995, 13(1):8-10. DOI:10.1200/JCO.1995.13.1.8.
[2]
Weichselbaum RR, Hellman S. Oligometastases revisited[J]. Nat Rev Clin Oncol, 2011, 8(6):378-382. DOI:10.1038/nrclinonc.2011.44.
[3]
国家肿瘤质控中心乳腺癌专家委员会, 中国抗癌协会乳腺癌专业委员会, 中国抗癌协会肿瘤药物临床研究专业委员会. 中国晚期乳腺癌规范诊疗指南(2024版)[J]. 中华肿瘤杂志, 2024, 46(12):1079-1106. DOI:10.3760/cma.j.cn112152-20241009-00435.
[4]
Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET):A randomised,phase 2,open-label trial[J]. Lancet, 2019, 393(10185):2051-2058. DOI:10.1016/S0140-6736(18)32487-5.
[5]
Lievens Y, Guckenberger M, Gomez D, et al. Defining oligometastatic disease from a radiation oncology perspective:An ESTRO-ASTRO consensus document[J]. Radiother Oncol, 2020, 148:157-166. DOI:10.1016/j.radonc.2020.04.003.
[6]
Cardoso F, Paluch-Shimon S, Schumacher-Wulf E, et al. 6th and 7th international consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)[J]. Breast, 2024, 76:103756. DOI:10.1016/j.breast.2024.103756.
[7]
Cardoso F, Paluch-Shimon S, Senkus E, et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5)[J]. Ann Oncol, 2020, 31(12):1623-1649. DOI:10.1016/j.annonc.2020.09.010.
[8]
Pasquier D, Bidaut L, Oprea-Lager DE, et al. Designing clinical trials based on modern imaging and metastasis-directed treatments in patients with oligometastatic breast cancer:A consensus recommendation from the EORTC imaging and breast cancer groups[J]. Lancet Oncol, 2023, 24(8):e331-e343. DOI:10.1016/S1470-2045(23)00286-3.
[9]
Terao M, Niikura N. Diagnosis of oligometastasis[J]. Transl Cancer Res, 2020, 9(8):5032-5037. DOI:10.21037/tcr.2020.01.04.
[10]
Kosmin M, Makris A, Joshi PV, et al. The addition of whole-body magnetic resonance imaging to body computerised tomography alters treatment decisions in patients with metastatic breast cancer[J]. Eur J Cancer, 2017, 77:109-116. DOI:10.1016/j.ejca.2017.03.001.
[11]
Giuliano AE, Edge SB, Hortobagyi GN. Eighth edition of the AJCC cancer staging manual:Breast cancer[J]. Ann Surg Oncol, 2018, 25(7):1783-1785. DOI:10.1245/s10434-018-6486-6.
[12]
Gradishar WJ, Moran MS, Abraham J, et al. NCCN guidelines® insights:breast cancer,version 4.2023[J]. J Natl Compr Canc Netw, 2023, 21(6):594-608. DOI:10.6004/jnccn.2023.0031.
[13]
Chinese Society of Breast Surgery. Clinical practice guidelines for pre-operative evaluation of breast cancer:Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021[J]. Chin Med J (Engl), 2021, 134(18):2147-2149. DOI:10.1097/CM9.0000000000001520.
[14]
中华医学会外科学分会乳腺外科学组. 初诊Ⅳ期乳腺癌诊疗临床实践指南(2025版)[J]. 中国实用外科杂志, 2025, 45(12):1403-1409. DOI:10.19538/j.cjps.issn1005-2208.2025.12.11.
[15]
中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)乳腺癌诊疗指南2025[M]. 北京: 人民卫生出版社, 2025.
[16]
Slanetz PJ, Moy L, Baron P, et al. ACR appropriateness criteria® monitoring response to neoadjuvant systemic therapy for breast cancer[J]. J Am Coll Radiol, 2017, 14(suppl11):462-475. DOI:10.1016/j.jacr.2017.08.037.
[17]
中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)中枢神经系统转移性肿瘤诊疗指南2024[M]. 北京: 人民卫生出版社, 2024.
[18]
中国抗癌协会乳腺癌专业委员会, 中华医学会肿瘤学分会乳腺肿瘤学组. 中国抗癌协会乳腺癌诊治指南与规范(2026年版)[J]. 中国癌症杂志, 2025, 35(12): 1157-1255. DOI:10.19401/j.cnki.1007-3639.2025.12.009.
[19]
Rong J, Wang S, Ding Q, et al. Comparison of 18FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis[J]. Surg Oncol, 2013, 22(2):86-91. DOI:10.1016/j.suronc.2013.01.002.
[20]
Ulaner GA, Castillo R, Goldman DA, et al. (18)F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer[J]. Eur J Nucl Med Mol Imaging, 2016, 43(11):1937-1944. DOI:10.1007/s00259-016-3402-9.
[21]
Vogsen M, Jensen JD, Christensen IY, et al. FDG-PET/CT in high-risk primary breast cancer-a prospective study of stage migration and clinical impact[J]. Breast Cancer Res Treat, 2021, 185(1):145-153. DOI:10.1007/s10549-020-05929-3.
[22]
Vaz SC, Woll JPP, Cardoso F, et al. Joint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer:(endorsed by the ACR,ESSO,ESTRO,EUSOBI/ESR,and EUSOMA)[J]. Eur J Nucl Med Mol Imaging, 2024, 51(9):2706-2732. DOI:10.1007/s00259-024-06696-9.
[23]
Guckenberger M, Lievens Y, Bouma AB, et al. Characterisation and classification of oligometastatic disease:A european society for radiotherapy and oncology and european organisation for research and treatment of cancer consensus recommendation[J]. Lancet Oncol, 2020, 21(1):e18-e28. DOI:10.1016/S1470-2045(19)30718-1.
[24]
Turner NC, Kingston B, Kilburn LS, et al. Circulating tumour DNA analysis to direct therapy in advanced breast cancer (plasmaMATCH):A multicentre,multicohort,phase 2a,platform trial[J]. Lancet Oncol, 2020, 21(10):1296-1308. DOI:10.1016/S1470-2045(20)30444-7.
[25]
Turner NC, Swift C, Jenkins B, et al. Results of the c-TRAK TN trial:A clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer[J]. Ann Oncol, 2023, 34(2):200-211. DOI:10.1016/j.annonc.2022.11.005.
[26]
Chinese Society of Breast Surgery. Clinical practice guidelines for ultrasound-guided breast lesions and lymph nodes biopsy:Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021[J]. Chin Med J (Engl), 2021, 134(12):1393-1395. DOI:10.1097/CM9.0000000000001549.
[27]
Chinese Society of Breast Surgery. Clinical practice guidelines for ultrasound-guided vacuum-assisted breast biopsy:Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021[J]. Chin Med J (Engl), 2021, 134(12):1390-1392. DOI:10.1097/CM9.0000000000001508.
[28]
中国抗癌协会乳腺癌专业委员会. 晚期乳腺癌基因检测临床应用指南(2025版)[J]. 中华肿瘤杂志, 2025, 47(10):946-960. DOI:10.3760/cma.j.cn112152-20250618-00279.
[29]
Ly BH, Nguyen NP, Vinh-Hung V, et al. Loco-regional treatment in metastatic breast cancer patients:Is there a survival benefit?[J]. Breast Cancer Res Treat, 2010, 119(3):537-545. DOI:10.1007/s10549-009-0610-z.
[30]
Shien T, Hara F, Aogi K, et al. Primary tumour resection plus systemic therapy versus systemic therapy alone in metastatic breast cancer (JCOG1017,PRIM-BC):A randomised clinical trial[J]. Br J Cancer, 2025, 133(5):625-632. DOI:10.1038/s41416-025-03097-z.
[31]
Khan SA, Zhao F, Goldstein LJ, et al. Early Local Therapy for the primary site in de Novo stage Ⅳ breast cancer:Results of a randomized clinical trial (EA2108)[J]. J Clin Oncol, 2022, 40(9):978-987. DOI:10.1200/JCO.21.02006.
[32]
Soran A, Ozmen V, Ozbas S, et al. Primary surgery with systemic therapy in patients with de Novo stage Ⅳ breast cancer:10-year follow-up; Protocol MF07-01 randomized clinical trial[J]. J Am Coll Surg, 2021, 233(6):742-751.e5. DOI:10.1016/j.jamcollsurg.2021.08.686.
[33]
Soran A, Dogan L, Isik A, et al. The effect of primary surgery in patients with de novo stage Ⅳ breast cancer with bone metastasis only (protocol BOMET MF 14-01):A multi-center,prospective registry study[J]. Ann Surg Oncol, 2021, 28(9):5048-5057. DOI:10.1245/s10434-021-09621-8.
[34]
Gu Y, Wu G, Zou X, et al. Prognostic value of site-specific metastases and surgery in de Novo stage Ⅳ triple-negative breast cancer:A population-based analysis[J]. Med Sci Monit, 2020, 26:e920432. DOI:10.12659/MSM.920432.
[35]
Nierenberg TC, Thomas SM, Halliday I, et al. Locally ablative therapies in oligometastatic breast cancer[J]. JAMA Surg,2026: e260098. DOI:10.1001/jamasurg.2026.0098.[Epubaheadofprint].
[36]
Lan B, Abudureheiyimu N, Zhang J, et al. Clinical features and prognostic factors for extracranial oligometastatic breast cancer in China[J]. Int J Cancer, 2020, 147(11):3199-3205. DOI:10.1002/ijc.33152.
[37]
Tsai CJ, Yang JT, Shaverdian N, et al. Standard-of-care systemic therapy with or without stereotactic body radiotherapy in patients with oligoprogressive breast cancer or non-small-cell lung cancer (consolidative use of radiotherapy to block [CURB] oligoprogression):An open-label,randomised,controlled,phase 2 study[J]. Lancet, 2024, 403(10422):171-182. DOI:10.1016/S0140-6736(23)01857-3.
[38]
Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers:Long-term results of the SABR-COMET phase II randomized trial[J]. J Clin Oncol, 2020, 38(25):2830-2838. DOI:10.1200/JCO.20.00818.
[39]
Trovo M, Furlan C, Polesel J, et al. Radical radiation therapy for oligometastatic breast cancer:Results of a prospective phase Ⅱ trial[J]. Radiother Oncol, 2018, 126(1):177-180. DOI:10.1016/j.radonc.2017.08.032.
[40]
Chmura SJ, Winter K A, Woodward WA, et al. NRG-BR002:A phase ⅡR/Ⅲ trial of standard of care systemic therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical resection (SR) for newly oligometastatic breast cancer (NCT02364557)[J]. J Clin Oncol, 2022, 40(suppl 16):1007. DOI: 10.1200/JCO.2022.40.16_suppl.1007.
[41]
Friedel G, Pastorino U, Ginsberg RJ, et al. Results of lung metastasectomy from breast cancer:Prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases[J]. Eur J Cardiothorac Surg, 2002, 22(3):335-344. DOI:10.1016/s1010-7940(02)00331-7.
[42]
Mimoto R, Kobayashi T, Imawari Y, et al. Clinical relevance and low tumor-initiating properties of oligometastatic breast cancer in pulmonary metastasectomy[J]. Breast Cancer Res Treat, 2014, 147(2):317-324. DOI:10.1007/s10549-014-3111-7.
[43]
Chen F, Fujinaga T, Sato K, et al. Clinical features of surgical resection for pulmonary metastasis from breast cancer[J]. Eur J Surg Oncol, 2009, 35(4):393-397. DOI:10.1016/j.ejso.2008.05.005.
[44]
Meimarakis G, Rüttinger D, Stemmler J, et al. Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer[J]. Ann Thorac Surg, 2013, 95(4):1170-1180. DOI:10.1016/j.athoracsur.2012.11.043.
[45]
Planchard D, Soria JC, Michiels S, et al. Uncertain benefit from surgery in patients with lung metastases from breast carcinoma[J]. Cancer, 2004, 100(1):28-35. DOI:10.1002/cncr.11881.
[46]
Abbott DE, Brouquet A, Mittendorf EA, et al. Resection of liver metastases from breast cancer:Estrogen receptor status and response to chemotherapy before metastasectomy define outcome[J]. Surgery, 2012, 151(5):710-716. DOI:10.1016/j.surg.2011.12.017.
[47]
Margonis GA, Buettner S, Sasaki K, et al. The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer:A multi-institutional analysis[J]. HPB (Oxford), 2018, 20(10):916-924. DOI:10.1016/j.hpb.2018.03.013.
[48]
Chun YS, Mizuno T, Cloyd JM, et al. Hepatic resection for breast cancer liver metastases:Impact of intrinsic subtypes[J]. Eur J Surg Oncol, 2020, 46(9):1588-1595. DOI:10.1016/j.ejso.2020.03.214.
[49]
Mariani P, Servois V, De Rycke Y, et al. Liver metastases from breast cancer:Surgical resection or not? A case-matched control study in highly selected patients[J]. Eur J Surg Oncol, 2013, 39(12):1377-1383. DOI:10.1016/j.ejso.2013.09.021.
[50]
Grazi GL. Renewed considerations on the utility (or the futility) of hepatic resections for breast cancer liver metastases[J]. Hepatobiliary Surg Nutr, 2021, 10(1):49-58. DOI:10.21037/hbsn.2019.07.12.
[51]
Hoffmann K, Franz C, Hinz U, et al. Liver resection for multimodal treatment of breast cancer metastases:Identification of prognostic factors[J]. Ann Surg Oncol, 2010, 17(6):1546-1554. DOI:10.1245/s10434-010-0931-5.
[52]
Bilani N, Elson L, Liang H, et al. Effect of surgery at primary and metastatic sites in patients with stage IV breast cancer[J]. Clin Breast Cancer, 2021, 21(3):170-180. DOI:10.1016/j.clbc.2020.08.008.
[53]
Pagani O, Senkus E, Wood W, et al. International guidelines for management of metastatic breast cancer:Can metastatic breast cancer be cured?[J]. J Natl Cancer Inst, 2010, 102(7):456-463. DOI:10.1093/jnci/djq029.
[54]
Millen JCA, Hofmann A, Mesquita-Neto JW, et al. Evolving role of liver resection in selected patients with metastatic breast cancer[J]. J Surg Res, 2021, 259:363-371. DOI:10.1016/j.jss.2020.09.022.
[55]
Bai XM, Yang W, Zhang ZY, et al. Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer[J]. Int J Hyperthermia, 2019, 35(1):183-193. DOI:10.1080/02656736.2018.1488279.
[56]
Meloni MF, Andreano A, Laeseke PF, et al. Breast cancer liver metastases:US-guided percutaneous radiofrequency ablation--intermediate and long-term survival rates[J]. Radiology, 2009, 253(3):861-869. DOI:10.1148/radiol.2533081968.
[57]
Ohri N, Tomé WA, Méndez Romero A, et al. Local control after stereotactic body radiation therapy for liver tumors[J]. Int J Radiat Oncol Biol Phys, 2021, 110(1):188-195. DOI:10.1016/j.ijrobp.2017.12.288.
[58]
Van Poznak C, Somerfield MR, Barlow WE, et al. Role of bone-modifying agents in metastatic breast cancer:An american society of clinical oncology-cancer care ontario focused guideline update[J]. J Clin Oncol, 2017, 35(35):3978-3986. DOI:10.1200/JCO.2017.75.4614.
[59]
Barrett-Lee P, Casbard A, Abraham J, et al. Oral ibandronic acid versus intravenous zoledronic acid in treatment of bone metastases from breast cancer:A randomised,open label,non-inferiority phase 3 trial[J]. Lancet Oncol, 2014, 15(1):114-122. DOI:10.1016/S1470-2045(13)70539-4.
[60]
中国抗癌协会骨肿瘤和骨转移瘤专业委员会. 乳腺癌骨转移临床诊疗专家共识[J]. 中国肿瘤临床, 2022, 49(13):660-669. DOI:10.12354/j.issn.1000-8179.2022.20211783.
[61]
Scorsetti M, Franceschini D, De Rose F, et al. Stereotactic body radiation therapy:A promising chance for oligometastatic breast cancer[J]. Breast, 2016, 26:11-17. DOI:10.1016/j.breast.2015.12.002.
[62]
Patchell RA, Tibbs PA, Regine WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain:A randomized trial[J]. JAMA, 1998, 280(17):1485-1489. DOI:10.1001/jama.280.17.1485.
[63]
Kaidar-Person O, Meattini I, Jain P, et al. Discrepancies between biomarkers of primary breast cancer and subsequent brain metastases:An international multicenter study[J]. Breast Cancer Res Treat, 2018, 167(2):479-483. DOI:10.1007/s10549-017-4526-8.
[64]
Wroński M, Lederman G. A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis[J]. Cancer, 1997, 80(5):1002-1004. DOI:10.1002/(sici)1097-0142(19970901)80:5<1002::aid-cncr30>3.0.co;2-c.
[65]
Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain[J]. N Engl J Med, 1990, 322(8):494-500. DOI:10.1056/NEJM199002223220802.
[66]
Vecht CJ, Haaxma-Reiche H, Noordijk EM, et al. Treatment of single brain metastasis:Radiotherapy alone or combined with neurosurgery?[J]. Ann Neurol, 1993, 33(6):583-590. DOI:10.1002/ana.410330605.
[67]
Meattini I, Andratschke N, Kirby AM, et al. Challenges in the treatment of breast cancer brain metastases:Evidence,unresolved questions,and a practical algorithm[J]. Clin Transl Oncol, 2020, 22(10):1698-1709. DOI:10.1007/s12094-020-02333-7.

脚注

利益冲突 参与本指南编写及投票的专家委员会成员均声明无利益冲突

基金

辽宁省科技计划联合计划项目技术攻关项目(2024JH2/102600315)
中国乳腺疾病规范诊治专病队列研究项目(KC2025-JX-0003-3)

PDF(1342 KB)

Accesses

Citation

Detail

段落导航
相关文章

/