随着新辅助系统治疗在乳腺癌临床中的应用持续深化，乳腺外科的诊疗理念与策略正在经历全方位的迭代升级。手术早已不是孤立的局部干预手段，而是与全身治疗深度联动，在“精准降阶”与“保障根治”之间寻求动态平衡的关键环节。如何把握外科降阶的合理边界？一项降阶策略从临床试验走向国际指南，需要遵循怎样的评判标准？中欧之间的诊疗协作又该在哪些方向重点发力？10月10日-11日，以“九秩仁心筑梦 医路薪火相传”为主题的2026华东乳腺沙龙于南京举办。期间，《肿瘤瞭望》专访了奥地利维也纳医科大学Michael Gnant教授，就新辅助治疗背景下外科决策的价值内核、降阶策略向临床指南转化的关键依据，以及中欧乳腺外科领域的科研协作方向等重要问题，带来国际前沿的观察与思考。
编者按：随着新辅助系统治疗在乳腺癌临床中的应用持续深化，乳腺外科的诊疗理念与策略正在经历全方位的迭代升级。手术早已不是孤立的局部干预手段，而是与全身治疗深度联动，在“精准降阶”与“保障根治”之间寻求动态平衡的关键环节。如何把握外科降阶的合理边界？一项降阶策略从临床试验走向国际指南，需要遵循怎样的评判标准？中欧之间的诊疗协作又该在哪些方向重点发力？10月10日-11日，以“九秩仁心筑梦 医路薪火相传”为主题的2026华东乳腺沙龙于南京举办。期间，《肿瘤瞭望》专访了奥地利维也纳医科大学Michael Gnant教授，就新辅助治疗背景下外科决策的价值内核、降阶策略向临床指南转化的关键依据，以及中欧乳腺外科领域的科研协作方向等重要问题，带来国际前沿的观察与思考。
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《肿瘤瞭望》：您在本次大会的议题聚焦“新辅助全身治疗背景下的外科考量”。随着新辅助治疗在乳腺癌临床实践中的应用日益广泛，外科治疗的理念和策略也在持续演变。从外科医生的视角来看，新辅助治疗对外科决策带来的核心意义是什么？在“手术降级”与“保障长期预后”等方面，当前有哪些关键问题尚未形成共识？
Michael Gnant 教授：奥地利维也纳医科大学新辅助系统治疗是推动现代乳腺外科发展的重要驱动力之一。它不仅能让原本不可手术的患者获得手术机会，更推动术式从乳房全切向保乳治疗转变，我们正朝着逐步缩减乳房全切术适用范围的方向稳步迈进。除此之外，新辅助治疗过程中呈现的肿瘤应答特征，还能为术后治疗方案的制定提供重要参考，至少在部分乳腺癌亚型中，病理完全缓解是极具价值的预后预测指标。然而，目前领域内仍存在不少有待研究验证的争议，比如如何将外科降阶的理念最优地应用于Luminal型乳腺癌，以及当前已有的腋窝手术降阶策略，是否同样适用于新辅助系统治疗后的患者群体。
《Oncology Frontier》: Your presentation at this conference focuses on "Surgical Considerations in the Context of Neoadjuvant Systemic Therapy." As neoadjuvant therapy is increasingly applied in breast cancer clinical practice, the concepts and strategies of surgical management continue to evolve. From a surgeon's perspective, what is the core significance of neoadjuvant therapy in shaping surgical decision-making? Between "surgical de-escalation" and "ensuring long-term prognosis," what key issues currently remain without consensus?
Professor Michael Gnant: Neoadjuvant systemic therapy stands as one of the pivotal forces driving advances in modern breast surgery. It not only converts initially inoperable cases into operable ones, but also shifts the treatment paradigm from mastectomy toward breast-conserving therapy — we are making steady progress toward gradually narrowing the indications for mastectomy. Beyond that, tumor response patterns observed during neoadjuvant treatment offer important guidance for postoperative treatment planning. At least in certain breast cancer subtypes, pathological complete response serves as a highly robust prognostic biomarker.
That said, multiple controversies in the field still await research validation. For instance, how to optimally apply surgical de-escalation principles to luminal breast cancer, and whether established de-escalation strategies for axillary surgery remain applicable in patients who have received neoadjuvant systemic therapy.
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《肿瘤瞭望》：作为St.Gallen国际乳腺癌共识会议主席，面对新辅治疗后保乳、豁免腋窝淋巴结清扫、精准放疗等“降阶梯”的议题，应怎样判断一个策略可以从“临床研究的降阶”升级为“可写进国际标准的降阶”？需要看哪些关键指标？
Michael Gnant 教授：归根结底，最根本的衡量指标始终是患者的总生存期。对早期乳腺癌而言，总生存期的提升往往意味着实现临床治愈。除此之外，保乳率是评价乳腺外科疗效的重要维度，同时尽可能减少局部区域治疗与全身治疗的不良反应、持续改善患者生存质量，也是临床决策中至关重要的考量标准。
《Oncology Frontier》: You have long served as Chairman of the St. Gallen International Breast Cancer Consensus Conference, which provides important guidance for the development of global breast cancer treatment standards. When faced with de-escalation issues such as breast conservation, omission of axillary lymph node dissection, and precision radiotherapy after neoadjuvant therapy, how should one judge whether a strategy can progress from "de-escalation in clinical trials" to "de-escalation suitable for adoption in international guidelines"? What key metrics matter most?
Professor Michael Gnant: When all is said and done, patient overall survival remains the most fundamental endpoint. For early-stage breast cancer, improvement in overall survival is essentially equivalent to achieving clinical cure. In addition, breast conservation rate is a key outcome metric for breast surgical care. Meanwhile, minimizing adverse effects from both locoregional and systemic treatments, and sustaining improvement in patients’ quality of life, are also indispensable considerations in clinical decision-making.
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《肿瘤瞭望》：您持续积极推动与中国乳腺癌学界的合作。在您看来，中欧在乳腺癌外科临床研究领域的合作应优先聚焦哪些方向？对于本次华东乳腺沙龙上中国同道的学术分享，您有哪些特别的关注和期待？
Michael Gnant 教授：近年来，中国乳腺癌的研究水平与临床诊疗质量均取得了长足进步。依托国内高水平的学术研究机构与乳腺疾病诊疗中心，中国的科研产出质量与患者诊疗标准都得到了显著提升。早期筛查项目的推广、诊疗指南体系的搭建，以及质量控制机制的完善，共同推动着中国在全球乳腺癌研究领域的影响力持续提升，其中中国临床肿瘤学会乳腺癌专家委员会（CSCO-BC）、中国抗癌协会乳腺癌专业委员会（CACA-CBCS）等优秀学术组织开展的工作，发挥了非常重要的作用。下一阶段的方向，我认为是进一步拓展全球化合作项目，合作不应只局限于产业层面，更要构建起学术研究与临床试验层面的深度协作网络。
《Oncology Frontier》: You have actively promoted collaboration with the Chinese breast cancer academic community in recent years. In your view, what directions should China-Europe collaboration in breast cancer surgical clinical research prioritize? What particular aspects of the academic sharing by Chinese colleagues at this East China Breast Cancer Salon will you be paying attention to?
Professor Michael Gnant: China has achieved remarkable progress in breast cancer research and clinical care in recent years. Supported by top-tier academic institutions and specialized breast care centers across the country, China has significantly elevated both its research output quality and clinical care standards.
The rollout of early detection programs, the development of clinical guideline frameworks, and the establishment of quality assurance mechanisms have collectively strengthened China’s standing in the global breast cancer research community. Outstanding academic organizations such as the Chinese Society of Clinical Oncology Breast Cancer Committee (CSCO-BC) and the Chinese Anti-Cancer Association Breast Cancer Committee (CACA-CBCS) have made instrumental contributions to this progress.
Looking ahead, I believe the next step is to expand global collaborative initiatives. Partnership should not be confined to industry-level cooperation; more importantly, we need to build an in-depth collaborative network spanning academic research and clinical trial conduct.