乳腺癌多学科协作诊疗山东共识(2024年版)

摘要/Abstract

参考文献

多维度评价

doi:10.6040/j.issn.1671-7554.0.2024.0289

摘要： 乳腺癌作为威胁女性健康的头号恶性肿瘤,对我国医疗卫生事业造成沉重负担。虽然我国乳腺癌诊疗水平显著提高,但与西方国家仍存在差距。作为人口大省,山东省女性乳腺癌死亡率上升速度高于全国水平。目前乳腺癌已进入个体化综合诊疗时代,多学科诊疗(multidisciplinary treatment, MDT)模式通过专业协同合作,打破专业壁垒,已被证实能够提高治愈率和患者生活质量,也是缩小国内外患者生存差距的重要手段。尽管MDT诊疗理念已被专科医生广泛接受,但尚无可参考的乳腺癌MDT规范化流程及标准。在此背景下,结合循证医学证据,山东省医学会乳腺疾病多学科联合委员会针对乳腺癌MDT的会前准备、MDT实施及MDT后随访等问题进行投票,形成《乳腺癌多学科协作诊疗山东共识(2024年版)》。本共识的制定,旨在推动山东省乳腺癌MDT水平的同质化发展,切实提升我省乳腺癌规范化诊疗综合水平。

关键词: 山东省, 专家共识, 乳腺癌, 多学科诊疗, 综合治疗, 标准化

Abstract: As the most common malignant tumor occured in women, breast cancer has posed a serious threat to health and brought a heavy burden on medical services. Although individualized treatment has made great progress, there was still a gap in overall survival of breast cancer patients between China and western countries. In addition, the prevalence was higher in Shandong Province. Breast cancer has entered the era of individualised comprehensive treatment. By professional synergy and breaking down professional barriers, multidisciplinary treatment(MDT)mode has been proven to improve survival, enhance quality of life and narrow the gap. Although the concept of MDT has been widely accepted by specialists, there is no standardised process and standard for MDT in breast cancer. Based on the above background, combined with evidence-based medicine, Multidisciplinary Joint Committee on Breast Disease of Shandong Provincial Medical Association, after discussion and voting, formed Shandong Province expert consensus on multidisciplinary treatment of breast cancer(2024 edition), which integrated the relevant studies worldwide and combined with clinical practice. This consensus aims to promote the homogenization level of MDT and to improve the standard of diagnosis and treatment of breast cancer in Shandong Province.

Key words: Shandong Province, Expert consensus, Breast cancer, Multidisciplinary treatment, Comprehensive treatment, Standardization

中图分类号:

R737.9

山东省医学会乳腺疾病多学科联合委员会. 乳腺癌多学科协作诊疗山东共识(2024年版)[J]. 山东大学学报 (医学版), 2025, 63(1): 10-16.

[1] Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
[2] 郑荣寿,陈茹,韩冰峰,等. 2022年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志, 2024, 46(3): 221-231. ZHENG Rongshou, CHEN Ru, HAN Bingfeng, et al. Cancer incidence and mortality in China, 2022[J]. Chinese Journal of Oncology, 2024, 46(3): 221-231.
[3] 楚洁,鹿子龙,刘静,等. 1970—2013年山东省女性乳腺癌死亡时空变化趋势分析[J]. 中华预防医学杂志, 2022, 56(5): 609-613. CHU Jie, LU Zilong, LIU Jing, et al. Spatio-temporal trend of female breast cancer mortality in Shandong Province from 1970 to 2013[J]. Chinese Journal of Preventive Medicine, 2022, 56(5): 609-613.
[4] Fisher B. From halsted to prevention and beyond: advances in the management of breast cancer during the twentieth century[J]. Eur J Cancer, 1999, 35(14): 1963-1973.
[5] Whitehouse M. A policy framework for commissioning cancer services[J]. BMJ, 1995, 310(6992): 1425-1426.
[6] American Society of Clinical Oncology, European Society for Medical Oncology. ASCO-ESMO consensus statement on quality cancer care[J]. Ann Oncol, 2006, 17(7): 1063-1064.
[7] Friedman EL, Chawla N, Morris PT, et al. Assessing the development of multidisciplinary care: experience of the national cancer institute community cancer centers program[J]. J Oncol Pract, 2015, 11(1): e36-e43.
[8] 孙燕.肺癌非手术综合治疗233例分析[J].中国医学科学院学报, 1983, 6(1): 14-18. SUN Yan. Results of multimodality treatment in inoperable lung cancer: report of 233 cases[J]. Acta Academiae Medicinae Sinicae, 1983, 6(1): 14-18.
[9] 中华人民共和国国家卫生和计划生育委员会办公厅,国家中医药管理局办公室. 关于加强肿瘤规范化诊疗管理工作的通知[EB/OL].(2016-03-22)[2024-03-08]. http://www.nhc.gov.cn/yzygj/s3593/201603/53341b6ab1c14963acceb5d1f37540df.shtml.
[10] 中华人民共和国国家卫生健康委员会. 关于开展肿瘤多学科诊疗试点工作的通知[EB/OL].(2018-08-27)[2024-03-08]. http://www.nhc.gov.cn/yzygj/s3594q/201808/0cfe48391dd14876951cf6262e28c062.shtml.
[11] 中华人民共和国国家卫生健康委员会. 国家卫生健康委办公厅关于印发肿瘤专业医疗质量控制指标(2023年版)的通知[EB/OL].(2023-03-13)[2024-03-08]. http://www.nhc.gov.cn/yzygj/s7657/202303/d61a0abf132f4aaf9ebbb6d094764ad2.shtml.
[12] Yang XX, Huang JH, Zhu XP, et al. Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: an analysis of 4,501 consecutive patients[J]. Breast, 2020, 52: 135-145. doi:10.1016/j.breast.2020.05.008.
[13] Bortot L, Targato G, Noto C, et al. Multidisciplinary team meeting proposal and final therapeutic choice in early breast cancer: is there an agreement?[J]. Front Oncol, 2022, 12: 885992. doi:10.3389/fonc.2022.885992.
[14] Blackwood O, Deb R. Multidisciplinary team approach in breast cancer care: benefits and challenges[J]. Indian J Pathol Microbiol, 2020, 63(Supplement): S105-S112.
[15] 杨犇龙,吴炅. 乳腺癌多学科诊疗标准与规范(2023年版)[J]. 中国癌症杂志, 2023, 33(12): 1188-1203. YANG Benlong, WU Jiong. Standardization of multi disciplinary team treatment for breast cancer(2023 edition)[J]. China Oncology, 2023, 33(12): 1188-1203.
[16] 于胜吉,王锡山. 中国结直肠癌骨转移多学科综合治疗专家共识(2020 版)[J]. 中华结直肠疾病电子杂志, 2020, 9(3): 217-221. YU Shengji, WANG Xishan. Chinese experts consensus on multidisciplinary treatment of bone metastases from colorectal cancer(2020 version)[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 9(3): 217-221.
[17] 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.
[18] 中国抗癌协会妇科肿瘤专业委员会.妇科恶性肿瘤多学科诊疗中国专家共识(2022年版)[J]. 中国癌症杂志, 2022, 32(8): 747-756. The Society of Gynecological Cancer of China Anti-Cancer Association. China expert consensus on multidisciplinary diagnosis and treatment of gynecological malignant tumors(2022 edition)[J]. China Oncology, 2022, 32(8): 747-756.
[19] 钟文昭,吴一龙. 肺癌多学科团队诊疗中国专家共识[J]. 中华肿瘤杂志, 2020, 42(10): 817-828. ZHONG Wenzhao, WU Yilong. Chinses expert consensus on the multidisciplinary team diagnosis and treatment of lung cancer[J]. Chinese Journal of Oncology, 2020, 42(10): 817-828.
[20] Amir Z, Scully J, Borrill C. The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams[J]. Eur J Oncol Nurs, 2004, 8(4): 306-314.
[21] Brown T, Cruickshank S, Noblet M. Specialist breast care nurses for support of women with breast cancer[J]. Cochrane Database Syst Rev, 2021, 2(2): CD005634. doi: 10.1002/14651858.CD005634, pub3.
[22] 国家肿瘤质控中心乳腺癌专家委员会.中国乳腺癌规范诊疗质量控制指标(2022版)[J].中华肿瘤杂志, 2022, 44(3): 203-208. Breast Cancer Expert Committee of National Cancer Quality Control Center. Quality control index for standardized diagnosis and treatment of breast cancer in China(2022 Edition)[J]. Chinese Journal of Oncology, 2022, 44(3): 203-208.
[23] 中华人民共和国国家卫生健康委员会. 关于印发健康中国行动—癌症防治行动实施方案(2023—2030年)的通知[EB/OL].(2023-10-30)[2024-03-08]. https://www.gov.cn/zhengce/zhengceku/202311/content_69-15380.htm.
[24] 中华人民共和国国家卫生健康委员会.关于印发肿瘤诊疗质量提升行动计划的通知[EB/OL].(2021-10-18)[2024-03-08]. http://www.nhc.gov.cn/yzygj/s7659/202110/dea7d84638db44e28001fbd7d6c6801a.shtml.
[25] Selby P, Gillis C, Haward R. Benefits from specialised cancer care[J]. Lancet, 1996, 348(9023): 313-318.
[26] 中国临床肿瘤学会乳腺癌专家委员会,中国抗癌协会乳腺癌专业委员会,中华医学会外科学分会乳腺外科学组.中国年轻乳腺癌诊疗专家共识(2022)[J].中华医学杂志, 2023, 103(6): 387-403. Chinese Society of Clinical Oncology, Experts Committee on Breast Cancer, China Anti-Cancer Association, the Society of Breast Cancer, Chinese Medical Association, Chinese Society of Breast Surgery. Expert consensus on the diagnosis and treatment of young breast cancer in China(2022 Edition)[J]. National Medical Journal of China, 2023, 103(6): 387-403.
[27] Bevers TB, Niell BL, Baker JL, et al. NCCN guidelines insights: breast cancer screening and diagnosis, version 1. 2023[J]. J Natl Compr Canc Netw, 2023, 21(9): 900-909.
[28] 中华医学会外科学分会乳腺外科学组. 中国浸润性乳腺癌诊治临床实践指南(2022版)[J]. 中国实用外科杂志, 2022, 42(2): 121-127. Chinese Society of Breast Surgery, Chinese Society of Surgery, Chinese Medical Association. Clinical practice China guidelines for diagnosis and treatment of patients with invasive breast cancer(2022 edition)[J]. Chinese Journal of Practical Surgery, 2022, 42(2): 121-127.
[29] 周亚杰,王斐,于理想,等. 女性乳腺癌保乳手术决策相关因素[J]. 山东大学学报(医学版), 2022, 60(12): 1-6. ZHOU Yajie, WANG Fei, YU Lixiang, et al. Factors related to decision-making of breast-conserving surgery for female breast cancer[J]. Journal of Shandong University(Health Sciences), 2022, 60(12): 1-6.
[30] 林芸,谢燕秋. 乳腺癌患者生育力保护及保存[J]. 山东大学学报(医学版), 2022, 60(9): 42-46. LIN Yun, XIE Yanqiu. Fertility protection and preservation of breast cancer patients[J]. Journal of Shandong University(Health Sciences), 2022, 60(9): 42-46.
[31] 刘荫华,赵婧祎,辛灵. 美国临床肿瘤学会多基因检测临床实践指南更新及临床意义[J]. 山东大学学报(医学版), 2018, 56(1): 1-5. LIU Yinhua, ZHAO Jingyi, XIN Ling. Focused updates of American Society of Clinical Oncology Guideline on the use of multigene tests in clinical practice for breast cancer[J]. Journal of Shandong University(Health Sciences), 2018, 56(1): 1-5.
[32] Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline[J]. CA Cancer J Clin, 2016, 66(1): 43-73.
[33] 国家肿瘤质控中心乳腺癌专家委员会,北京乳腺病防治学会健康管理专业委员会.中国乳腺癌随诊随访与健康管理指南(2022版)[J]. 中华肿瘤杂志, 2022, 44(1): 1-28. Breast Cancer Expert Committee of National Cancer Quality Control Center, Health Management Professional Committee of Beijing Breast Cancer Prevention and Control Society. Comprehensive management guideline for breast cancer follow-up and healthcare(2022 edition)[J]. Chinese Journal of Oncology, 2022, 44(1): 1-28.

Just accepted

Online first

Just accepted

Online first

Viewed

Full text

From	Others	local

Times	16	77
Rate	17%	83%

Abstract

207

Just accepted	Online first	Issue

0	0	207

From	Others	local

Times	203	4
Rate	98%	2%

Cited

Web of Science	Crossref	ScienceDirect	Search for Citations in Google Scholar >>


This page requires you have already subscribed to WoS.

Shared

Discussed