提议国际抗癌联盟和美国癌症联合委员会分期系统修改炎性乳腺癌的概念
2017年4月1日，英国《柳叶刀肿瘤学分册》将正式发表美国德克萨斯大学MD安德森癌症中心、埃及开罗大学国家癌症研究所的观点文章，提议国际抗癌联盟（UICC）和美国癌症联合委员会（AJCC）TNM分期系统修改炎性乳腺癌的概念。
在缺乏区分炎性和非炎性乳腺癌的组织学标准情况下，炎性乳腺癌诊断完全依赖TNM分类所概述的现有临床标准。该分类将出现炎性乳腺癌特征临床标准的患者限于子类T4d，其不考虑肿瘤大小或淋巴结扩散，将所有非转移性炎性乳腺癌患者分入3期。出现转移性病变的患者被分入4期，并且TNM分类不根据现有炎性标准区分患者。本文作者团队和其他人的证据表明，炎性乳腺癌患者在诊断时出现远处转移（4期）的总生存显著降低。根据这些结果，本文阐述了目前的TNM分期分类是否精准体现了炎性与非炎性乳腺癌患者之间的区别。
炎性乳腺癌是一种罕见的特殊类型乳腺癌，肿瘤特点酷似急性炎症改变，乳腺弥漫性增大，乳腺皮肤红、肿、热、痛，易误诊为急性乳腺炎。约50%的炎性乳腺癌摸不到肿块，经病理诊断为乳腺癌。多数患者在诊断时就发现腋窝和/或锁骨上淋巴结转移。炎性乳腺癌发病率约占全部乳腺癌的2.0%，发病的平均年龄为52岁，病程进展快、预后差，转移发生率高达30%～40%，5年生存率仅为25%～48%。
Lancet Oncol. 2017 Apr;18(4):e228-e232.
Inflammatory breast cancer: a proposed conceptual shift in the UICC-AJCC TNM staging system.
Tamer M Fouad, Angelica M Gutierrez Barrera, James M Reuben, Anthony Lucci, Wendy A Woodward, Michael C Stauder, Bora Lim, Sarah M DeSnyder, Banu Arun, Babiera Gildy, Vicente Valero, Gabriel N Hortobagyi, Dr Naoto T Ueno.
University of Texas MD Anderson Cancer Center, Houston, TX, USA; The National Cancer Institute, Cairo University, Cairo, Egypt.
In the absence of histological criteria that distinguish between inflammatory and non-inflammatory breast cancer, diagnosis of inflammatory breast cancer relies entirely on the existence of clinical criteria as outlined by the TNM classification. This classification restricts patients presenting with clinical criteria characteristic of inflammatory breast cancer to subcategory T4d, which immediately relegates all patients with non-metastatic inflammatory breast cancer to stage 3, regardless of tumour size or nodal spread. Patients who present with metastatic disease are consigned to stage 4, and the TNM classification does not distinguish patients on the basis of the presence of inflammatory criteria. Evidence by our group and others suggests that patients with inflammatory breast cancer have significantly reduced overall survival among those who present with distant metastasis at diagnosis (stage 4). In light of these results, this Personal View addresses whether the current TNM staging classification accurately represents a distinction between patients with inflammatory and those with non-inflammatory breast cancer.
DOI: 10.1016/S1470-2045(17)30192-4