, 5. 6, :X (MR I), 6. 2 :,, 1 2 cm,,,,46,, :70, T 1,, 7. 2: 24,24 8, Hercep tin 7. 3: 4 10, 20%, 46MVX, 810MV X,,1 c

410 2007175 CH INA ONCOLOGY2007Vol. 17No. 5 (2007) X 1 1. 1 ( ) 1. 2,,35 cm, 1. 3, ;, X B 5 cm,3 cm MR I( ) ) 4. 3 2 2. 1 < 3 5 cm> 3 5. 1(1), cm ( ) 2. 2, 5. 2 3,, 3. 1,/ 3. 2, 5. 3,, 3. 3 ( 5. 4, ), 5 5% 7% (), : http: / /www. cbcs. cn / 3. 4 3. 5, 4 4. 1,2 cm,paget s 4. 2 > 3 cm( 3% 5%,

2007175 411 5. 5, 5. 6, 6 6. 1 :X (MR I), 6. 2 :,, 1 2 cm,,,,46,, 6. 3 7 7. 1:70, T 1,, 7. 2: 24,24 8, Hercep tin 7. 3: 4 10, 20%, 46MVX, 810MV X,,1 cm 12 cm (,, ),12 cm12 cm,,1. 5 2 cm,ct, 7. 4: 50 Gy,1. 82 Gy,5 60 Gy, 3 65

412 (2007) Gy, / 3 : 8, 9 9. 1:12,34 ; 3 51; 51 9. 2:/6,1X 13 4,MR I 9. 3, 9. 4 1 3 (1), (2) 1 5:(pT) 2 cm, a 1 b Her22 /neu c 35 51:(pT) > 2 cm, 23 Her22 < 35 Her22 Her22 a:/ ; b:,; ; c: Her22 F ISH C ISH 2 ER /PgR ERPgR 3 :2005 St. Gallen 2 2. 1, 2. 2, 70, 2. 3 (LVEF) 2. 4 ( ),: A 3 3,CAF A ( E) C CE 120 F FE 100 C ( C A E F) B,TAC( T ) C,ACT/P ( P )FECT D,,CMF (C M F)

2007175 413 3 3 :( THP),,, THP4050 mg/m 2,,, 85%,, 3 3. 1 ( ER /PgR ) 3. 2, 3. 3,Hercep tin 3. 4 ( ), 20 mg/d 5,1, B : A,, ; B, ; C ( GnRHa),, 23 GnRHaCMF 3. 5 ER/PgR, : A ; BHer22 /neu; C ; ; D20 mg/d 5 5( Letrozol /Anastrozol), 2332(Exemes2 tane / Anastrozol), 5 5 ( Letrozol) 20 mg/d 5, 1,B,,, 4Hercep tin 4. 1 Her22 /neu Her22 /neu:( IHC) 3 +,( F ISH ), (C ISH) Her22 IHC 2 +F ISH C ISH 4. 2 (LVEF) < 50% 4. 3 : Her22 /neu1 Hercep tin Hercep tin,10

414 (2007),, Hercep tin, Her22 /neu 4. 4 Her22 /neu () (, ) 4. 5 Hercep tin 6 mg/kg(8 mg/kg)3,, 2 mg/kg(4 mg/kg) ; 1, 48 h 3. 3, 2, 3. 4, 461 LVEF,, LVEF50%,,LVEF,,50% Hercep tin 4 4. 1 1 1. 1,( ) 1. 2 3 3 :,,,, 2 2. 1 ( ER, PgR, Her22 /neu, ) 2. 2, 2. 3, 3 3. 1,, 3. 2 :,, ; : () : X ( MR I) CT (LVEF), (),,,

2007175 415, 4. 2 3 3, :, CAFFAC ; (2) pcr AC CEF FEC [ C A ( ) E F ],A ( E) T TAC ( T),ACPAC T( P ),NE(N ) 3 3 4. 3 1, 2,,,,, 2,3, REC IST WHO ( ) CR, PR, SDPD,, CR PR : A; B 24(46 ),; CACP,2AC, 4P, 5 5. 1 5. 2 (pcr) : (1), (pcr),,,pcr ERPgR Her22,( ER ER ER,) 5. 3 : ;, :,, ; : X 1 X 1. 1:,, 1. 2: X X (MLO )(CC) MLO :,,,,,,,, CC

416 (2007) :,,,,) ; 1. 3 :MLO CC, :(LM ) (ML) (MCC) (LCC) ( CLEO ),, 2 [ 1 ] 2. 1X : :(75% ) ( 75% ) ( ) ()( ) :, :,, :(, ) ; ( ) ; ( ) ;(,, 1 mm,,,,) ; ;(1 mm, ) ;(1 mm,, (,CC,,90,, ) ;(,,, ) ; (,, 0. 5 mm, ) ; () 5, ; ( > 2 cm 3 ),,, ; 5( < 2 cm 3 ),;,,, ;, :,,,,, /:, :,, 1 cm,,,

2007175 :,,,,,,, :,,,,, : 2. 2 X (B I2RADS) X,, :,,X 0:,( recall) X,, : : ( ) X :,,( 6) 2% / 23 3 () () :,,, A B C, 30% :, ( ) 95% :,, 1, (B reast Imaging Reporting And Data System, B I2RADS) X 1 : XXXXXX 1. 1 ( ) ; () ; 1. 2 ; [,, () ] 2 417

418 (2007) 2. 1 (2003WHO,World Health O rganization Classi2 fication of Tumours, Pathology & Genetics, Tumours of the breast and Female Genital O rgans. taneh A. Tavassoli & Peter Devilee) Edited by Fat2 ( 3 WHO ) (1 cm,,; 1 cm,, ) ( ) 2. 2 10,, 3 /14 143( ) : A, ; B, 3 3. 1( ER ) ( PgR ) (, 1 + 3 + - Harvey JM, et al. J C lin Oncol, 1999, 17: 14742 1481) 3. 2Her22 /neu DakoHercepT2 est?,1 + 3 + - ( F ISH),, F ISH ( Jacobs TW, Gown AM, Yaziji H, B arnes MJ, Schm itt SJ. Specificity of Her2 ceptest in Determ ining HER22 /neu Status of B reast Cancers U sing the United States Food and D rug Ad2 m inistration2app roved Scoring System. Journal of Clin2 ical Oncology, 1999, 17 ( 7) : 1983) 3. 3,P53 Ki67 4 Her22 /neuf ISH ( )C ISH ( ) 5 1 1. 1,,, 1. 2,, 2 2. 140 2. 2(), 3 3. 1 X X, (CC)(MLO) X X, 35,

2007175 X X, 3. 2, X, X 3. 3,,, 710 3. 4 X; X B I2RADS20 3. 5(MR I) X X () 3. 6 4 4. 1 40< 60 :1 X 6069 :121 X 40:131 1 XB 4. 2 : BRCA1 /2, 6 121 X,X,MR I 1 419 ""200611,,"" ST. Gallen NC2 CN,, "",, 12 "" " ",

420 (2007) :,15%, CM F 100 mg/m 2 50 mg/m 2 500 mg/m 2 PO d114 d8 d8 281,6 CE 120 F 100 mg/m 2 50260 mg/m 2 500 mg/m 2 PO d114 d8 d8 281,6 M FC 50 mg/m 2 500 mg/m 2 500 mg/m 2 d8 d8 d8 281,6 AC & 60 mg/m 2 600 mg/m 2 211,4 EC 100 mg/m 2 600 mg/m 2 211,46 FAC & 500 mg/m 2 50 mg/m 2 500 mg/m 2 211,6 TAC 3 & 75 mg/m 2 50 mg/m 2 500 mg/m 2 211,6 (G2CSF) AC P 3 & 60 mg/m 2 600 mg/m 2 211,4 175 mg/m 2 IV 3 h d1 211,4 AC P 3 & 60 mg/m 2 600 mg/m 2 141,4 175 mg/m 2 IV 3 h d1 141,4 ( G2CSF) FE 100 C 3 500 mg/m 2 100 mg/m 2 500 mg/m 2 211,6 FE 100 C T 3 500 mg/m 2 100 mg/m 2 500 mg/m 2 211,3 100 mg/m 2 90 m in d1 211,3

2007175 421,,,: NE 2530 mg/m 2 75 mg/m 2 d8 211,46 AT & 50 mg/m 2 75 mg/m 2 175 mg/m 2 75 mg/m 2 211,46 3 : :,(Baker AF et al. D rug interactions with the taxanes: clnical implicatins. treatment reviews 2001, 27: 2212233) Cancer &:,(A ), ( THP) (A) 3 3,, : A B 60 C < 60, 12,, FSH, 1 (LHRH ) 3 3 :NCCNV. 1. 2007 : 1 :, NCCN 2B :, NCCN, ( SD ) : 50%, 25% 1WHO ( PD ) : 25%, (CR) :, ( PR ) : 2WHO 50%, CR: X,,

422 (2007) PR: ; SD:,SD 8 PD:/ : 3REC IST (Response Evalua2 tion Criteria in Solid Tumors, REC IST) 1979WHO, 1994, WHO,, WHO,, REC IST,2000,,,, 4 4. 1 : CT10 mm, 20 mm; CT5 mm, 10 mm 4. 2:,, 20 mm, CT10 mm ;, ; ; 4. 3 :WHO,, 5,, (,, ) 6,,, CT,,, X,CT B,, B CR,,CR,,, CR 7,, 7. 1:, 20 mm,ct10 mm, 5, 10, 7. 2 :, 10, ;

2007175, 8 8. 1LD:, (LD ),, LD : 1. 5 () + 2. 5 () + 2. 0 ( ) + 2. 0 () = 8. 0 cm ( LD) LD 8. 2 423 CR: PR:LD, LD 30% (LD, ) PD:,, LD ;, LD,LD,LD 20%, PD SD:LD PR; PD : A, 9 cm 5 cm 4 cm,pr;pr TTP (), 1PR,3PD,,1 PR, 2,3 TTP,TTP B, 1,2 30%, 3, PR,, SD 1 2,3,9 cm 6 cm, 30%,PR, TTP,, 8. 3 CR: PR:PR SD ( CR ) :,/ PD:,/,,, 8. 4

424 (2007) REC IST,, : A,X CT,, CT X B,,, PD,TTP C,,,,,PD D,,, 8. 5 A,,CRPR SD 4, B, LD 20%,,, C,, 8. 6 CR CR CR CR CR PR PR PD SD SD SD PD PD PD (,) () CR CR PR PR PD SD PD SD

2007175 425 X XXXXXXX : 58687 : XXX : : 49 : 2006210221 / : 217166 : 809 : : XXX : : :() :() : 2. 8 cm 1. 8 cm,,,, : : B I2RADS: 5 : B I2RADS: 1 : XXX: XXX: 2006210222 :,,,: 00000000

426 (2007) XXXXXX : 2006210924 : XXX : : 49 : 2006210224 : 217166 : 809 : : XXX : : ( ) : : : 4 cm 2. 5 cm 2 cm : : ( + ) : ( - ) : ( - ) : ( - ) : ( - ) : / : : : : : : : 4 /14: / : / : ( - ) : ( - ) : : ER: 1 ( + ) PgR: 1 ( + ) c2erbb22 /neu: 2 ( + ) : XXX: XXX: 2006210230 :,,: 00000000

2007175 427 [ ] [ ] TNM (AJCC) TNM (2003) 1( T) ( T) T 1 T 2 T 3, X,T 1 0. 1 cm T X T 0 Tis Tis(DC IS) :; Tis(LC IS) :; Tis( Paget s) :Paget s, :Paget s T 1 : 2 cm T 1m ic :, 0. 1 cm; :,, ;, T 1a : > 0. 1 cm, 0. 5 cm; T 1b : > 0. 5 cm, 1 cm; T 1c : > l cm, 2 cm T 2 : > 2 cm, 5 cm T 3 : > 5 cm T 4 :, ( a) ( b), : T 4a :,; T 4b :( ),, ; T 4c : T 4a T 4b ; T 4d : 2 (N) 2. 1 N X : () N 0 : N 1 :, N 2 :,;. 3 N 2a :, ; N 2b : 3,; N 3 : ; 3 ;, N 3a :; N 3b : ; N 3c : 3 :( ), 2. 2 (pn ) a pn X : (, ) pn 0 :, ( isolated tumor cell, ITC) : ITC:, 0. 2 mm, ( IHC),HE ITCs

428 (2007) pn 0 ( i2) :, IHC ; pn 0 ( i + ) :, IHC,0. 2 mm; pn 0 (mol2) :, (RT2PCR) b ; pn 0 (mol + ) :, (RT2PCR) b a: pn,, ( sn),pn 0 ( i + ) ( sn) ; b: RT2PCR: / pn 1 : 13,/,, 3 3 pn 1m i :( > 0. 2 mm, < 2. 0 mm) ; pn la : 13; pn lb :,, 3 3 ; pn lc : 123, 3 3 ( > 3, pn 3b ) pn 2 : 49;, pn 2a : 49( > 2. 0 mm) ; pn 2b : 3, pn 3 : 10,, 3, 1; 3 ; pn 3a : 10( > 2. 0 mm ), ; pn 3b : 3, 1; 3,, 3 3 ; pn 3c : 3 : :( ) ; 3 3 : :( ) 3(M ) M X : M 0 : M 1 : 4 Stage T stage N stage M stage Stage 0 Tis N 0 M 0 Stage T 1 N 0 M 0 Stage A T 0 N 1 M 0 T 1 N 1 M 0 T 2 N 0 M 0 Stage B T 2 N 1 M 0 T 3 N 0 M 0 Stage A T 0 N 2 M 0 T 1 N 2 M 0 T 2 N 2 M 0 T 3 N 12 M 0 Stage B T 4 N 02 M 0 Stage C T N 3 M 0 Stnge T N M 1 :,,4, T 1 T 1m ic