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2025年美国国立综合癌症网络（National Comprehensive Cancer Network, NCCN）乳腺癌指南V4版与中国临床肿瘤学会（Chinese Society of Clinical Oncology, CSCO）乳腺癌诊疗指南同步聚焦乳腺癌精准医疗与全程管理，在循证医学新证据支撑下完成核心更新。本文系统对比2版指南在分子分型与生物标志物检测、早期乳腺癌新辅助/辅助治疗和晚期乳腺癌解救治疗3个方面的更新亮点。经对比发现，2版指南对人表皮生长因子受体2(human epidermal growth factor receptor 2, HER2)低表达/超低表达的界定、抗体药物偶联物（antibody-drug conjugate, ADC）药物临床地位跃升、免疫治疗场景拓展和细胞周期蛋白依赖性激酶4/6(cyclin-dependent kinases 4/6, CDK4/6)抑制剂联合策略优化等方面形成高度共识；同时因中国和美国在医疗体系、药物可及性现状和人群特征的差异，2版指南在推荐强度分级、方案选择优先级和本土化适配策略等方面存在显著区别。本文通过解析指南背后的循证证据与差异存在的底层原因，为临床医师平衡国际标准与本土实践提供参考，助力乳腺癌诊疗的规范化、个体化与可及性统一。
Abstract：In 2025, the version 4 of the National Comprehensive Cancer Network(NCCN) breast cancer guidelines and the Chinese Society of Clinical Oncology(CSCO) breast cancer diagnosis and treatment guidelines simultaneously focus on the precision medicine and comprehensive management of breast cancer, completing core updates supported by new evidence from evidence-based medicine. In this article, we systematically compares the updated highlights of the two editions of the guidelines in three aspects: molecular typing and biomarker testing, neoadjuvant/adjuvant treament for early breast cancer, and salvage treatment for advanced breast cancer. Through comparison, it was found that the two editions of the guidelines have reached a high degree of consensus on the definition of human epidermal growth factor receptor 2(HER2) low/ultra-low expression, the clinical status of antibody-drug conjugate(ADC) drugs, the expansion of the application scenarios of immunotherapy, and the optimization of the combination strategy of cyclin-dependent kinases 4/6(CDK4/6) inhibitors. At the same time, due to the differences in medical systems, current status of drug accessibility, and population characteristics between China and the United States, there are significant differences in recommendation grading, the priority of treatment options, and localization adaptation strategies between the two editions. By analyzing the evidence behind the guidelines and the underlying reasons for the differences, this paper provides a reference for clinicians to balance international standards and local practices, and helps to unify the standardization, individualization, and accessibility of breast cancer diagnosis and treatment.
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基本信息:
DOI：10.13267/j.cnki.syzlzz.2026.030
引用信息:
[1]董银萍,宋华,袁洋,等.2025年美国国立综合癌症网络和中国临床肿瘤学会乳腺癌指南更新要点对比解读[J],2026,41(3):211-219.DOI:10.13267/j.cnki.syzlzz.2026.030.