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2例妊娠相关乳腺癌患者的病例报道及相关文献复习 Δ

金司爻 1，2＊ ，赵志刚 ，霍记平 （1.首都医科大学附属北京天坛医院药学部，北京 100160；2.首都医科大学药学
1 #
1
院临床药学系，北京 100069）

中图分类号 R73；R969 文献标志码 A 文章编号 1001-0408（2020）08-0989-08
DOI 10.6039/j.issn.1001-0408.2020.08.17

摘 要 目的：为妊娠相关乳腺癌（PABC）的早期诊断和治疗方案的选择提供参考。方法：对我院2例PABC患者的疾病特征、治
疗过程和预后情况等进行分析；检索PubMed数据库中1986年1月－2019年4月发表的相关文献，纳入标题、关键词或摘要中包括
“Breast cancer and pregnancy”“Pregnancy-associated breast cancer”“Breast cancer during pregnancy”“Breast carcinoma during preg-
nancy”“Case reports”等的病例报告，排除不符合PABC定义的病例报告，对其中患者的基本资料、肿瘤临床特征、药物治疗方案、
母胎/婴预后等信息进行汇总及描述性统计分析。结果与结论：我院2例患者均于哺乳期确诊，经新辅助化疗和手术切除后，预后
良好。通过文献检索与筛选获得共36篇病例报告，共45例患者（39例患者在妊娠期间确诊，6例患者在哺乳期间确诊）的临床资
料。排除未报道相关信息的病例后，35.0％（14/40）的病例应用了新辅助化疗AC方案（多柔比星+环磷酰胺）；59.5％（22/37）的病
例进行了择期剖腹产手术，37.8％（14/37）的病例经阴道分娩，1例终止妊娠；患者存活率为80.8％（21/26），婴儿平均出生体质量为
2 407 g（1 015～3 830 g）。分别有6例和9例患者在妊娠期和产后使用了紫杉烷类药物。PABC化疗方案的确定应综合考虑多方
因素，需要全面权衡母亲及婴儿的受益风险，尽量避免在妊娠早期进行化疗，尤其要兼顾化疗对胎儿的影响。化疗方案仍以蒽环
类药物为主导，可在此基础上制订个体化方案，且使用紫杉醇类药物时应充分权衡利弊并进行严密监测。
关键词 妊娠相关乳腺癌；病例报道；文献综述；新辅助化疗；化疗相关不良反应；预后

Case Reports of Two Patients with Pregnancy-associated Breast Cancer and Related Literature Review
1
1
JIN Siyao ，ZHAO Zhigang ，HUO Jiping（1. Dept. of Pharmacy，Beijing Tiantan Hospital，Capital Medical
1，2
University，Beijing 100160，China；2. Dept. of Clinical Pharmacology，College of Pharmaceutical Sciences，
Capital Medical University，Beijing 100069，China）
ABSTRACT OBJECTIVE：To provide reference for the early diagnosis and selection of treatment regimens of pregnancy-
associated breast cancer（PABC）. METHODS：The disease characteristics，treatment process and prognosis of 2 cases of PABC
were analyzed in our hospital. The relevant literature published from Jan. 1986 to Apr. 2019 in PubMed database was retrieved. The
case reports that the title，keywords or abstracts involved“Breast cancer and pregnancy”“Pregnancy-associated breast cancer”
“Breast cancer during pregnancy”“Breast carcinoma during pregnancy”“Case reports”were included. Cases which didn’t meet the
definition of PABC were excluded. The general information，tumor clinical characteristics，drug treatment plan，maternal/fetal
prognosis and other information of patients were extracted for summary and descriptive statistical analysis. RESULTS &
CONCLUSIONS：Two patients were both diagnosed during lactation. The prognosis was good after neoadjuvant chemotherapy and
surgical resection. A total of 36 case reports were obtained through literature search and screening，as well asclinical data of 45
patients（39 diagnosed during pregnancy and 6 diagnosed during lactation）.Neoadjuvant chemotherapy AC regimen（doxorubicin+
cyclophosphamide）was used in 35.0％（14/40）of cases after excluding the cases without relevant information；elective caesarean
section was performed in 59.5％ （22/37） of cases，37.8％ （14/37） of cases were delivered，and 1 case chose to terminate
pregnancy；survival rate of patients was 80.8％（21/26），and the average weight of newborns was 2 407 g（1 015-3 830 g）. Six
patients each received taxanes during pregnancy and 9 patients during postpartum. The determination of chemotherapy for PABC
should comprehensively consider a variety of factors. It is necessary to comprehensively weigh the benefit risks of the mother and
child，try to avoid chemotherapy in early pregnancy，and especially consider the impact of chemotherapy on the fetus. The
chemotherapy regimen is still dominated by anthracyclines. Based on this，an individualized regimen is formulated and close
monitoring should be performed when using paclitaxel.
KEYWORDS Pregnancy-associated breast cancer；Case report；Literature review；Neoadjuvant chemotherapy；Chemotherapy-
related adverse reactions；Prognosis

Δ 基金项目：北京市医院管理局重点医学专业发展计划资助项目
妊娠期乳腺癌或妊娠相关乳腺癌（Pregnancy-asso-
（No.ZYLX201827）
ciated breast cancer，PABC）是指妊娠期间、产后第 1 年
＊硕士研究生。研究方向：临床药学。E-mail：TTEstelle@163.com
# 通信作者：主管药师，博士。研究方向：临床药理学、医院药 或哺乳期内任何时间确诊的乳腺癌。据报道，肿瘤占到
学。电话：010-59976867。E-mail：gaoshan-523@163.com 孕期死亡的 0.02％～0.1％，PABC 是妊娠期肿瘤中较为

中国药房 2020年第31卷第8期 China Pharmacy 2020 Vol. 31 No. 8 ·989 ·