《乳腺癌辅助治疗规范的解读课件》由会员分享，可在线阅读，更多相关《乳腺癌辅助治疗规范的解读课件（93页珍藏版）》请在金锄头文库上搜索。
1、乳腺癌辅助治疗规范的解读乳腺癌辅助治疗规范的解读1乳腺癌辅助治疗规范的解读TreatmentGuidelinesareusefulGuidelinesprovideabenchmarkandintegratenewfindingsintoclinicalpracticeTheyaredynamicdocuments,whichneedperiodicupdateTheyaredevelopedtoreduceunder-treatment,over-treatmentandwrongtreatmentCompliancewithguidelineshasbeenshowntoimprovepa
2、tientoutcome2乳腺癌辅助治疗规范的解读AdjuvantTherapyforBreastCancerTreatmentGuidelines7883889295980103058085902000GuidelinesSt. GallenNIHNCCN96yearly07如何掌握、使用如何掌握、使用？3乳腺癌辅助治疗规范的解读讨论内容讨论内容辅助治疗对哪些人有益？辅助治疗对哪些人有益？如何选择哪种辅助治疗方法？如何选择哪种辅助治疗方法？化疗方案的选择化疗方案的选择分子靶向治疗作用分子靶向治疗作用内分泌治疗方法的选择内分泌治疗方法的选择4乳腺癌辅助治疗规范的解读AdaptedfromBon
3、adonnaG.Cancer Res.1992.AllPatientsAllPatients1 13 35 57 79 91111131315years15yearsLOG-RANK:P=0.002LOG-RANK:P=0.002WILCOXON:P=0.0001WILCOXON:P=0.000110010050500 0%Relapse-freesurvival%Relapse-freesurvivalCMFCMFSurgerySurgery36%36%26%26%1 13 35 57 79 91111131315years15yearsLOG-RANK:P=0.02LOG-RANK:P=0
4、.02WILCOXON:P=0.02WILCOXON:P=0.0210010050500 0%Overallsurvival%OverallsurvivalCMFCMFSurgerySurgery51%51%35%35%BreastCancer:AdjuvantCMF(12months)orSurgeryAlonePremenopausalPremenopausal5乳腺癌辅助治疗规范的解读30yearsfollowupofrandomisedstudiesofadjuvantCMFinOperablebreastcancer:cohortstudyRelapsefreesurvival Ov
5、erallsurvival BonadonnaBMJ330:217,2005复发相对危险降低复发相对危险降低 34%HR 0.71 ( P = 0.005 )各种死亡降低各种死亡降低 22%HR 0.79 ( P = 0.04 )6乳腺癌辅助治疗规范的解读30yearsfollowupofrandomisedstudiesofadjuvantCMFinOperablebreastcancer:cohortstudyOverallsurvival BonadonnaBMJ330:217,20057乳腺癌辅助治疗规范的解读ComparativeEfficacyofAdjuvantChemother
6、apy:EBCTCGMeta-AnalysesTherapyReductioninAnnualOdds,%RecurrenceDeathPolychemotherapyvs23.515nochemotherapy(1995)(P.00001)(P.00001)Anthracyclinesvs1211CMF(1995)(P=.006)(P=.02)Anthracyclinesvs10.815.7CMF(2000)(P=.0005)(P.00001)8乳腺癌辅助治疗规范的解读2000OxfordOverviewAnalysisA/E+vsCMF:AllDeaths0.51.52.015.7%(SE
7、3.)reduction2p0.00001Deaths/WomenAllocatedAdjustedA/E+CMF*A/E+DeathsLogrankVarianceOEofOEYearCodeandStudyNameMonths&Treatment76A4 SECSG 26FAC v 6CMF93/26089/268-2.941.678L2 ONCOFRANCE12FACV v 12CMF52/13858/113-10.925.080C1 SE Sweden BCG A8AC v 7CMF (+R)8/2113/22-2.25.080M INT Milan8CMF+4A v 12CMF-/2
8、11-/212(no data)83A NSABC Israel Br02832CMF+4AVbCMF v 6CMF23/5521/50-1.310.184B NSABP B-15*4AC3CMF v 6CMF (+R)716/15622(374/776)-14.8224.784K1 GUN-3 Naples3CMFEV v 6CMF45/10558/115-5.223.784L ICCG Charing Cross8/6FEC v 6CMF20/25632/259-5.511.884Q2 Austrian BCSG 36CMFVA v 6CMF67/12175/124-3.130.885Y1
9、 PRONACAM85 N+/PreFECM v CMF(no data)86G2 NHG Japan10FAC c 10CMF ( Tam)(no data)87D4+5+6 GABG 3 Germany6FEC v 6CMF ( Tam)52/14260/146-7.523.687Q1 PRONACAM 874/5CMFEP v 6CMF(no data)88R Brussels Belgium*8EC v 6CMF138/5372(69/267)2.144.188V H San Carlos, Madrid6FAC v 6CMF(no data)89B2 SWOG 88976FAC v
10、6CMF (+RTam)173/1461223/1470-25.997.189R NCI-C MA.56FEC v 6CMF118/356135/360-10.159.189W123456c Denmark-Sweden*9FEC V9CMF (+Pmd)150/6010.8(290/781)-31.891.091H NSABP B-23 ER-AC v CMF (+Tam)91/1003100/1005-5.546.891Q GUN MAM1 NaplesZolTaM+(A;CMF v CMF)34/23243/234-3.818.294J1+2+3 GOIRC SANG 2B Italy6
11、CMFEV v 6CMF (+Tam)(no data)Scottish4E;4CMF v 8CMF(no data)1780/6850(26.0%)-128.42019/6906(29.2%)752.5Total*99%or95%CIA/E+betterCMFbetterTreatmenteffect2p0.1;NS141trialwithnodatadoesnotcontributetototal(allocatedA/E+:211;allocatedCMF:212)*Forbalance,controlpatientsin3-waytrialstratacounthalfortwicei
12、nsubtotal(s)andinfinaltotalofevents/women.1.00(? Patients)(100 Patients)(322 Patients)(158 Patients)( 480 Patients)(? Patients)RatioofannualdeathratesA/E+:CMF9乳腺癌辅助治疗规范的解读10乳腺癌辅助治疗规范的解读11乳腺癌辅助治疗规范的解读HER2predictsbenefitfromadjuvantpaclitaxelafterACinnode-positivebreastcancer:CALGB9344D.F.Hayes ASCO 2
13、006 Abs510ALLER-HER2-2%(-3,8)8%(-2,18)-1%(-8,5)HER2+22%(12,32)31%(17,44)9%(-6,24)ALL7%(2,12)16%(8,24)0%(-6,7)ER+12乳腺癌辅助治疗规范的解读BCIRG001StudyDesignDocetaxel 75 mg/m2 Doxorubicin 50 mg/m2Cyclophosphamide 500 mg/m25-FU 500 mg/m2Doxorubicin 50 mg/m2Cyclophosphamide 500 mg/m2FACTACRDexamethasone premedica
14、tion, 8 mg bid, 3 days Prophylactic Cipro 500 mg bid, day 5-14Every 3 weeks x 6 cyclesStratification:Nodes: 1-3 4+Center13乳腺癌辅助治疗规范的解读TACFAC0612182430364248MonthsNumberatRiskTACFAC7457367106786543731522317467296996566053341503105060708090100%AliveandDiseaseFree# EventsRRp-valueTAC1190.680.0011FAC170
15、Total289DiseaseFreeSurvival(ITT)BCIRG 001Medianfollow-up:33months82%74%14乳腺癌辅助治疗规范的解读NumberatRiskTACFAC745741732718700393171241746738728713678375171331# EventsRRp-valueTAC 570.760.11FAC 76Total133OverallSurvival(ITT)BCIRG001TACFAC0612182430364248Months5060708090100%Alive92%87%Medianfollow-up:33month
16、s15乳腺癌辅助治疗规范的解读DiseaseFreeSurvivalbyHormonalStatusTACFAC012243648MonthsNatRiskTACFAC2312171884702282021583405060708090100%AliveandDiseaseFreeTACFAC012243648MonthsNatRiskTACFAC514493466105151849744711605060708090100NegativePositiveRR = 0.62p = 0.005RR = 0.68p = 0.0216乳腺癌辅助治疗规范的解读17乳腺癌辅助治疗规范的解读18乳腺癌辅助
17、治疗规范的解读19乳腺癌辅助治疗规范的解读EPI 120 mg/m2 D1 Q21D 4CCTX 600 mg/m2 D1,8 MTX 40 mg/m2 D1,8 Q28D 4C 5-FU 600 mg/m2 D1,8 R1998,6-2002,7972 N+Taxit216multicenterphaseIIItrialSequential Epirubicin-Docetaxel-CMF as adjuvant therapy of early breast cancerA(ECMF)n=486EPI 120 mg/m2 D1 Q21D 4CD 100mg/m2 D1 Q21D 4CCTX
18、 600 mg/m2 D1,8 MTX 40 mg/m2 D1,8 Q28D 4C 5-FU 600 mg/m2 D1,8 B(ETCMF)n=486A. R. Bianco ASCO 2006 LBA52020乳腺癌辅助治疗规范的解读Taxit216multicenterphaseIIItrialSequential Epirubicin-Docetaxel-CMF as adjuvant therapy of early breast cancerA. R. Bianco ASCO 2006 LBA520 AsofMarch27th2006,medianfollowupwas53month
19、sDFSat5years:67%inarmAvs74%inarmBHazardRatio(HR)of0.80(95%CI:0.62-1.03,p=0.079)Afteradjustementbypredefinedbalancingfactors(ER,Nodalandmenopausalstatus)HRwas0.78(95%CIs:0.61-1.00;p=0.05).AsforOS,117deathswereobservedwithHRof0.74(95%CIs:0.51-1.07,p=0.10)Followupupdateisstillongoing21乳腺癌辅助治疗规范的解读22乳腺癌
20、辅助治疗规范的解读蒽环类蒽环类+ +紫杉类可延生存期紫杉类可延生存期DFSOSJCO2008,26(1):4423乳腺癌辅助治疗规范的解读蒽环类蒽环类+ +紫杉类可延生存期紫杉类可延生存期JCO2008,26(1):4424乳腺癌辅助治疗规范的解读蒽环类蒽环类+ +紫杉类可延生存期紫杉类可延生存期JCO2008,26(1):44DFSOS25乳腺癌辅助治疗规范的解读不同紫杉用法的差异不同紫杉用法的差异NEnglJMed2008,358(16):1663DFS26乳腺癌辅助治疗规范的解读不同紫杉用法的差异不同紫杉用法的差异OSNEnglJMed2008,358(16):166327乳腺癌辅助治疗
21、规范的解读28乳腺癌辅助治疗规范的解读NCCTGN9831BCIRG006FISHN+/-ACPDDCarbo标准方案标准方案HERAIHCorFISH赫赛汀赫赛汀1或或2年年观察组观察组NSABPB-31IHCorFISHIHCorFISHIHC,免疫组织化学免疫组织化学;FISH,荧光原位杂交荧光原位杂交赫赛汀赫赛汀治疗治疗1年年赫赛汀辅助治疗临床试验赫赛汀辅助治疗临床试验赫赛汀赫赛汀1年年赫赛汀赫赛汀1年年(联合或序贯联合或序贯)赫赛汀赫赛汀1年年(联合联合)赫赛汀赫赛汀1年年(联合联合)AC-TAC-TAC-TAC-TAC-DAC-DTCHTCH标准方案标准方案标准方案标准方案29乳腺
22、癌辅助治疗规范的解读NSABPB-31NCCTGN9831Arm1Arm2ArmAArmBArmCACq3wk*4=paclitaxelq3wk*4=paclitaxelq1wk*12=trastuzumabq1wHERA(Randomizationafterchemotherapy)ArmANoHerceptinArmBArmC(1yr)(2yr)=trastuzumabq3w30乳腺癌辅助治疗规范的解读CombinedanalysisofB31/N9831ControlHerceptinArm1(B31)Arm2(B31)ArmA(N9831)ArmC(N9831)Combined:n=3
23、,351;medianfollow-up2.0yrNSABPB-31:n=1,736;medianfollow-up2.4yrN9831:n=1,615;medianfollow-up1.5yr31乳腺癌辅助治疗规范的解读87%87%85%85%67%75%NEventsACT1679261ACTH 1672134%HR=0.48,2P=3x10-12ACACTHTHACTYearsFromRandomizationCombinedAnalysisforDFSofNSABPB-31/NCCTGN983132乳腺癌辅助治疗规范的解读HazardRatio0.20.40.60.81.01.21.4
24、ForestPlotForDFS:B31/N9831ProtocolNo.PositiveNodesTumorSizeHormoneReceptorAgeN9831NSABPB-314.1cm2.1-4.0cm2.0cmPositiveNegative6050-5940-4939ALLDATA10+4-91-3033乳腺癌辅助治疗规范的解读AnnualHazardofDistantRecurrence01234020406080100120Rateper1000Women/YrYearsFromRandomizationACACTHTHACT34乳腺癌辅助治疗规范的解读CombinedAnal
25、ysisforOSofNSABPB-31/NCCTGN9831ACACTHTH94%94%91%91%87%92%ACTNDeathsACT167992ACTH 167262HR=0.67,2P=0.015YearsFromRandomizationB31/N983135乳腺癌辅助治疗规范的解读Months from randomizationMonths from randomization0 05 5101015152020252516931693142814289949945805802802808787169416941472147210671067629629303303102102
26、EventsEvents2-yr2-yrDFS %DFS %HRHR95% CI95% CIp valuep value12712785.885.80.540.54 0.43, 0.670.43, 0.67 0.00010.000122022077.477.4Trastuzumab 1 yrTrastuzumab 1 yrObservationObservation% alive and % alive and disease freedisease free1001009090808070706060505040403030202010100 0No. No. at riskat riskD
27、FS:HERATrial36乳腺癌辅助治疗规范的解读012AllAny, neo-adjuvant chemotherapyNodal status0 pos, no neo-adjuvant chemotherapy338735811008722032307n0.540.530.520.770.640.43Hazardratio1-3 pos, no neo-adjuvant chemotherapy 4 pos, no neo-adjuvant chemotherapyNo anthracycline or taxaneAdjuvant chemotherapy regimenAnthra
28、cycline, no taxaneAnthracycline + taxaneNegativeReceptor status/endocrine therapyPos + no endocrine therapyPos + endocrine therapy35 yrs35-49 yrs50-59 yrs 60 yrs9729530.510.5316740.5146712340.490.682510.47149010910.520.535490.70AllAny, neo-adjuvant chemotherapyNodal status0 pos, no neo-adjuvant chem
29、otherapy338735811008722032307n0.540.530.520.770.640.43Hazardratio1-3 pos, no neo-adjuvant chemotherapy 4 pos, no neo-adjuvant chemotherapyNo anthracycline or taxaneAdjuvant chemotherapy regimenAnthracycline, no taxaneAnthracycline + taxaneNegativeReceptor status/endocrine therapyPos + no endocrine t
30、herapyPos + endocrine therapy2-5cmBCIRG0062-5cm5cm0.00.52.51.01.52.00-2cmN9831/B-310-2cm5cmACDH2cmDCarboH10+nodesDCarboHN-N+N+BCIRG006N-ACDHN-HERAHRSlamonetal2006Perezetal2007;Smithetal200740乳腺癌辅助治疗规范的解读无论年龄大小，赫赛汀均显示无论年龄大小，赫赛汀均显示DFSDFS获益获益35-49years0.00.52.51.01.52.0HERA35years50-59years60yearsN9831
31、/B-31 650.6 %1.3 %In both age groups about 10% of the patients had a LVEF of 50-54,about 50% of the patients had a LVEF of 55-64, and 35% had a LVEF of 65%. Average risk of early CHF for patient younger than 50 is 2 % and older than 50 is 5%ThisanalysisfromB31dataalone.43乳腺癌辅助治疗规范的解读RiskofCardiacEve
32、nts(nostrongevidenceofanmajordelayedtoxicity)The only cardiac death that occurred during this study occurred in a control patient. End of Herceptin treatment periodThisanalysisfromB31dataalone.44乳腺癌辅助治疗规范的解读Slamonetal2006Rastogietal2007Suteretal2007Perezetal2008赫赛汀辅助治疗的心脏安全性赫赛汀辅助治疗的心脏安全性aDatanotcomp
33、arableduetodifferentassessmentcriteriaCHF,congestiveheartfailure;cum,cumulativeincidenceLVEF,leftventricularejectionfraction;NR,notreported3.0NRNR18.08.6AsymptomaticLVEFdecline,%aH1yearACPHACPHACDHDCarboHArmHERANSABPB-31NCCTGN9831BCIRG0061,6789475701,0681,056nSevereCHF,%0.63.8cum(5yr)3.3cum(3yr)1.90
34、.4Cardiacdeath,n0000045乳腺癌辅助治疗规范的解读HER2状态判断状态判断IHC免疫组化免疫组化FISH荧光原位杂交荧光原位杂交CISH显色原位杂交显色原位杂交SISH银染原位杂交银染原位杂交46乳腺癌辅助治疗规范的解读Estimationoftheepidemiologicaleffectoftrastuzumabover20yearsinfiveEuropeancountriesASCO2008,abst,661147乳腺癌辅助治疗规范的解读ASCO2008,abst,6611Estimationoftheepidemiologicaleffectoftrastuzum
35、abover20yearsinfiveEuropeancountries48乳腺癌辅助治疗规范的解读HER2阳性乳腺癌治疗原则阳性乳腺癌治疗原则 使早期乳腺癌患者复发风险降低使早期乳腺癌患者复发风险降低36%52%,死亡风险死亡风险降低降低33% ACTH: ( H4 mg/kg,与首次与首次T同时使用同时使用; 然后然后H 2 mg/kg维持维持1年。或年。或T结束后结束后,H6 mg/kg维持维持1年年 ) 每每3周方案周方案, 目前推荐治疗时间为目前推荐治疗时间为1年年 在开始治疗的第在开始治疗的第3、6、9、18个月监测心脏情况个月监测心脏情况H辅助治疗的标准疗程为辅助治疗的标准疗程为
36、1年年,至少应治疗至少应治疗6个月以保个月以保证患者最大获益证患者最大获益 49乳腺癌辅助治疗规范的解读St.Gallen200350乳腺癌辅助治疗规范的解读St.Gallen200351乳腺癌辅助治疗规范的解读St.Gallen200352乳腺癌辅助治疗规范的解读EvolutionofAdjuvantTreatmentofBreastCancer1970198019902000非蒽环类非蒽环类非蒽环类非蒽环类方案方案方案方案含蒽环类含蒽环类含蒽环类含蒽环类方案方案方案方案含紫杉类含紫杉类含紫杉类含紫杉类方案方案方案方案含赫赛丁含赫赛丁含赫赛丁含赫赛丁方案方案方案方案53乳腺癌辅助治疗规范的解
37、读54乳腺癌辅助治疗规范的解读CHEMOTHERAPYREGIMENS-ST.GALLEN2005IMPLICATIONSFORPATIENTCAREACx4CMFx6FAC,FECx6CAF,CEFx6A(E)CMFWithoutTaxanesTACACPorDWithTaxanesH55乳腺癌辅助治疗规范的解读CHEMOTHERAPYREGIMENS-ST.GALLEN2005IMPLICATIONSFORPATIENTCAREStandardEfficacySuperiorEfficacyACx4CMFx6FAC,FECx6CAF,CEFx6A(E)CMFWithoutTaxanesTA
38、CACPorDWithTaxanesComplexityToxicityEconomiccostButgreaterH56乳腺癌辅助治疗规范的解读ChoiceofAdjuvantRegimens57乳腺癌辅助治疗规范的解读低危患者：低危患者：CMF6周期或周期或AC、EC46周期周期 中危患者：中危患者：FAC或或FEC6周期周期 高危患者：高危患者：ACT，FEC3T3， TAC，ATC， 密集化疗密集化疗 乳腺癌按不同危险度治疗乳腺癌按不同危险度治疗58乳腺癌辅助治疗规范的解读Changesinchemotherapyregimensforolderwomenwithbreastcance
39、rwhoreceivedadjuvantchemotherapyforstageItoIIIbreastcancer59乳腺癌辅助治疗规范的解读小小 结结CMF有最长的远期疗效结果，至今仍用有最长的远期疗效结果，至今仍用含蒽环类化疗是目前最基础的标准方案含蒽环类化疗是目前最基础的标准方案含紫杉类的地位已得到不断证实及巩固含紫杉类的地位已得到不断证实及巩固 (某些亚组的疗效待进一步观察某些亚组的疗效待进一步观察)赫赛丁可增加化疗的效果赫赛丁可增加化疗的效果剂量密度已开始动摇了传统的三周疗法剂量密度已开始动摇了传统的三周疗法60乳腺癌辅助治疗规范的解读61乳腺癌辅助治疗规范的解读100个月的结果：
40、个月的结果：T21.8%A17.0%AbsoluteDifference:4.8%62乳腺癌辅助治疗规范的解读63乳腺癌辅助治疗规范的解读64乳腺癌辅助治疗规范的解读MA.17:TrialDesign Primaryendpoint:DFSSecondaryendpoints:OS/safety/QOL*n=2575 (efficacy); 2154 (safety) in the FEMARA arm.n=2582 (efficacy); 2145 (safety) in the placebo arm.Gossetal.N Engl J Med.2003;349:TBD.Randomiza
41、tion(Disease-free)TamoxifenPlaceboqdFEMARA(Letrozole)2.5mgqd*5yearsearlyadjuvant5yearsextendedadjuvant65乳腺癌辅助治疗规范的解读MA.17Results:Disease-FreeSurvivalbyTreatmentDuration(contd)Gossetal.N Engl J Med.2003;349:TBD.87%93%IncreasingbenefitinestimatedDFSwithtreatmentduration66乳腺癌辅助治疗规范的解读67乳腺癌辅助治疗规范的解读68乳腺
42、癌辅助治疗规范的解读69乳腺癌辅助治疗规范的解读70乳腺癌辅助治疗规范的解读71乳腺癌辅助治疗规范的解读72乳腺癌辅助治疗规范的解读73乳腺癌辅助治疗规范的解读ATACEXEMBIG1.98(BIGFEMTA)TAMOXIFENAIPLACEBOARNO(J)MA-17NSABPB33EXEM027TEAMEXETrialStrategiesinAdjuvantTherapy:AIs74乳腺癌辅助治疗规范的解读75乳腺癌辅助治疗规范的解读76乳腺癌辅助治疗规范的解读AI.AdjuvantTrials:DFSTAMATACBIG1-98IESABCSG/ARNOMA-1710.820.810.6
43、0.60.5P-values 0.010.0030.000050.00180.00008Medianfollow-up(m)332630.62628UPFRONTAIDELAYEDAI77乳腺癌辅助治疗规范的解读AI与与TAM的随机对照临床试验的随机对照临床试验 HazardratioMedianAromataseDisease-freeTimetodistantFu(m)inhibitorsurvivalmetastasesOS初始治疗：初始治疗：Aromataseinhibitorvs.TAMATAC100Anastrozole0.850.840.97BIG1-9851Letozole0.
44、820.810.91IES56Exemestane0.760.830.85ABCSG-8/ARNO-9528Anastrozole0.600.54NRITA64Anastrozole0.56NRNR序贯治疗：序贯治疗：TAM5年后年后AromataseinhibitorMA.1730Letozole0.580.600.82ABCSG6a60Anastrozol0.620.530.89NSABPB-3330Exemestane0.680.691.278乳腺癌辅助治疗规范的解读EndocrineTreatmentStrategiesinEarlyBreastCancer(Postmenopausa
45、lwomen)19801990200219701-2years5yearsTamoxifen3rdgenerationAISequenceofTam/AI79乳腺癌辅助治疗规范的解读乳腺癌的内分泌治疗乳腺癌的内分泌治疗80乳腺癌辅助治疗规范的解读SystemicTreatmentModalitiesinEarlyStageBreastCancerCONCLUSIONEndocrineTherapyPROGRESS+ChemotherapyPROGRESS+BiologicTherapyPROGRESS+Weneedtomoveto“tailored”Smartclinicaltrials!20
46、0881乳腺癌辅助治疗规范的解读乳腺癌危险度乳腺癌危险度9thStGallen200582乳腺癌辅助治疗规范的解读乳腺癌危险度乳腺癌危险度10thStGallen200783乳腺癌辅助治疗规范的解读Treatmentrecommendationfor“houmone-responsive”tumousPrimaryBreastCancer:ESMOClinicalRecommendationAnnalsofOncology,19:7-10,200884乳腺癌辅助治疗规范的解读AdjuvantChemotherapyPrimaryBreastCancer:ESMOClinicalRecommendationAnnalsofOncology,19:7-10,200885乳腺癌辅助治疗规范的解读86乳腺癌辅助治疗规范的解读Prognosis87乳腺癌辅助治疗规范的解读88乳腺癌辅助治疗规范的解读89乳腺癌辅助治疗规范的解读90乳腺癌辅助治疗规范的解读91乳腺癌辅助治疗规范的解读个体化治疗个体化治疗个体化治疗个体化治疗92乳腺癌辅助治疗规范的解读THANK YOU !93乳腺癌辅助治疗规范的解读
