34例妊娠合并乳腺癌临床研究并文献复习

doi:10.3877/cma.j.issn.2095-3259.2026.02.003

目的

探讨妊娠合并乳腺癌的孕期管理和预后。

方法

回顾性分析2006年1月1日至2025年3月31日在我院治疗的34例妊娠合并乳腺癌患者的临床资料，分析其临床特点、妊娠结局和预后。

结果

34例患者年龄为23~42岁，平均(32.56±5.58)岁，多在妊娠中晚期确诊(28例，82.35%)，其中晚期乳腺癌11例，孕激素受体及雌激素受体均为阴性者11例(35.49%)；34例患者中28例选择继续妊娠。28例继续妊娠患者中妊娠期行乳腺癌根治术3例，其中1例足月分娩，2例分别在孕33周和31^＋3周分娩；乳腺癌手术联合化疗2例，均足月分娩；妊娠期单纯化疗15例，化疗方案均采用表柔比星＋环磷酰胺方案，平均延长孕周(13.30±5.52)周，平均分娩孕周为(36.35±1.78)周；未治疗8例。新生儿随访生长发育正常。引产和分娩后患者均进行了乳腺癌综合治疗，随访至今，28例存活，3例失访，3例患者因全身转移死亡。

结论

妊娠合并乳腺癌在妊娠中晚期手术或化疗相对安全，新生儿结局亦良好。

关键词: 乳腺肿瘤, 妊娠, 孕期管理, 临床结局

Objective

To explore the monitoring and prognosis of pregnancies complicated with breast cancer.

Methods

A retrospective analysis was conducted on 34 patients with pregnancy complicated with breast cancer who were treated at our hospital from January 1, 2006 to March 31, 2025. Their clinical characteristics, pregnancy outcomes, and prognosis were analyzed.

Results

The 34 patients ranged in age from 23 to 42 years, with a mean age of 32.56±5.58 years. Most cases were diagnosed in the second and third trimesters (28 cases, 82.35%), of which 11 were advanced breast cancer. The double-negative rate (both progesterone receptor and estrogen receptor negative) was 35.49% (11 cases). Among the 34 patients, 28 chose to continue their pregnancy. Of these 28 patients, 3 underwent radical mastectomy during pregnancy: one delivered at term, and two delivered at 33 weeks and 31^{+ 3} weeks of gestation, respectively. 2 patients received surgery combined with chemotherapy and both delivered at term. 15 patients received chemotherapy alone during pregnancy, all using the EC regimen (epirubicin + cyclophosphamide), with an average prolongation of gestation of 13.30±5.52 weeks and a mean gestational age at delivery of 36.35±1.78 weeks. 8 patients received no treatment. Newborns were followed up and showed normal growth and development. After induced labor or delivery, all patients received comprehensive treatment for breast cancer. To date, 28 patients have survived, three were lost to follow-up, and three died due to systemic metastasis.

Conclusions

Surgery and/or chemotherapy are relatively safe for pregnancies complicated with breast cancer during the second and third trimesters, and the neonatal outcomes are favorable.

Key words: Breast cancer, Pregnancy, Pregnancy management, Clinical outcome

表1 15例妊娠合并乳腺癌选择孕期化疗患者的临床情况

病例	乳腺癌诊断孕周(周)	FIGO分期	ER/PR	HER-2检查	化疗疗程(个)	化疗效果	延长孕周(周)	分娩孕周(周)	新生儿结局
1	21	Ⅱ	ER(-)/PR(-)	未做	4	部分缓解	16	37	存活，未发现并发症
2	28	Ⅱ	ER(＋)/PR(＋)	阴性	2	部分缓解	10^＋1	38^＋1	存活，未发现并发症
3	30^＋2	Ⅳ	ER(-)/PR(-)	未做	3	部分缓解	7^＋5	38	存活，未发现并发症
4	20	Ⅰ	ER(-)/PR(-)	未做	5	部分缓解	17	37	存活，未发现并发症
5	24^＋3	Ⅲ	ER(＋)/PR(＋)	未做	4	部分缓解	12^＋5	37^＋1	存活，未发现并发症
6	30^＋1	Ⅱ	ER(＋)/PR(＋)	未做	2	疾病稳定	7^＋6	38	存活，未发现并发症
7	27^＋3	Ⅲ	ER(＋)/PR(＋)	未做	3	疾病稳定	10^＋5	38^＋1	存活，未发现并发症
8	22^＋3	Ⅱ	ER(-)/PR(-)	未做	3	疾病进展	11^＋4	34	存活，新生儿黄疸
9	21	Ⅱ	ER(＋)/PR(＋)	阴性	2	疾病进展	14^＋5	35^＋5	存活，新生儿黄疸、卵圆孔未闭
10	29	Ⅱ	ER(＋)/PR(＋)	阳性	3	疾病进展	6^＋2	35^＋2	存活，未发现并发症
11	14	Ⅱ	ER(＋)/PR(＋)	未做	7	部分缓解	23^＋2	37^＋2	存活，未发现并发症
12	18^＋1	Ⅳ	ER(＋)/PR(-)	阴性	3	疾病进展	14^＋1	32^＋2	存活，新生儿黄疸
13	8	Ⅱ	ER(-)/PR(-)	阴性	3	疾病进展	25^＋6	33^＋6	存活，新生儿黄疸、卵圆孔未闭、呼吸窘迫综合征
14	27	Ⅳ	ER(＋)/PR(＋)	阳性	2	部分缓解	10^＋4	37^＋4	存活，未发现并发症
15	25	Ⅲ	ER(-)/PR(-)	未做	4	部分缓解	11^＋1	36^＋1	存活，新生儿黄疸

表1 15例妊娠合并乳腺癌选择孕期化疗患者的临床情况

病例	乳腺癌诊断孕周(周)	FIGO分期	ER/PR	HER-2检查	化疗疗程(个)	化疗效果	延长孕周(周)	分娩孕周(周)	新生儿结局
1	21	Ⅱ	ER(-)/PR(-)	未做	4	部分缓解	16	37	存活，未发现并发症
2	28	Ⅱ	ER(＋)/PR(＋)	阴性	2	部分缓解	10^＋1	38^＋1	存活，未发现并发症
3	30^＋2	Ⅳ	ER(-)/PR(-)	未做	3	部分缓解	7^＋5	38	存活，未发现并发症
4	20	Ⅰ	ER(-)/PR(-)	未做	5	部分缓解	17	37	存活，未发现并发症
5	24^＋3	Ⅲ	ER(＋)/PR(＋)	未做	4	部分缓解	12^＋5	37^＋1	存活，未发现并发症
6	30^＋1	Ⅱ	ER(＋)/PR(＋)	未做	2	疾病稳定	7^＋6	38	存活，未发现并发症
7	27^＋3	Ⅲ	ER(＋)/PR(＋)	未做	3	疾病稳定	10^＋5	38^＋1	存活，未发现并发症
8	22^＋3	Ⅱ	ER(-)/PR(-)	未做	3	疾病进展	11^＋4	34	存活，新生儿黄疸
9	21	Ⅱ	ER(＋)/PR(＋)	阴性	2	疾病进展	14^＋5	35^＋5	存活，新生儿黄疸、卵圆孔未闭
10	29	Ⅱ	ER(＋)/PR(＋)	阳性	3	疾病进展	6^＋2	35^＋2	存活，未发现并发症
11	14	Ⅱ	ER(＋)/PR(＋)	未做	7	部分缓解	23^＋2	37^＋2	存活，未发现并发症
12	18^＋1	Ⅳ	ER(＋)/PR(-)	阴性	3	疾病进展	14^＋1	32^＋2	存活，新生儿黄疸
13	8	Ⅱ	ER(-)/PR(-)	阴性	3	疾病进展	25^＋6	33^＋6	存活，新生儿黄疸、卵圆孔未闭、呼吸窘迫综合征
14	27	Ⅳ	ER(＋)/PR(＋)	阳性	2	部分缓解	10^＋4	37^＋4	存活，未发现并发症
15	25	Ⅲ	ER(-)/PR(-)	未做	4	部分缓解	11^＋1	36^＋1	存活，新生儿黄疸

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Pregnancy complicated with breast cancer: a clinical study of 34 cases and literature review

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Pregnancy complicated with breast cancer: a clinical study of 34 cases and literature review