第41届美国圣安东尼奥乳腺癌研讨会于2018年12月4～8日在美国得克萨斯州圣安东尼奥如期召开。笔者选取本次大会公布的乳腺癌外科手术治疗、化疗、靶向治疗、免疫治疗及内分泌治疗领域重要的研究数据分别进行解读和分享，以期为临床医师治疗和研究乳腺癌提供思路和参考。EORTC AMAROS研究10年随访数据提示，对于前哨淋巴结活组织检查阳性的原发性乳腺癌患者，采用腋窝放射治疗替代腋窝淋巴结清扫术是安全可行的。3期GEICAM/CIBOMA研究结果显示，早期三阴性乳腺癌患者完成手术和标准化疗后使用卡培他滨辅助治疗，并未显著改善生存。哈佛大学Meta分析结果提示，行新辅助化疗后达到pCR的患者，术后可豁免常规辅助化疗，不影响生存获益。中国邵志敏教授主持的多中心PEONY研究结果显示，在早期或局部晚期的HER-2阳性乳腺癌患者新辅助治疗中，帕妥珠单克隆抗体＋曲妥珠单克隆抗体＋多西他赛双靶向治疗组术后总体pCR率显著高于曲妥珠单克隆抗体＋多西他赛单靶向治疗组。KATHERINE研究表明，曲妥珠单克隆抗体-美坦新偶联物对早期HER-2阳性乳腺癌辅助治疗具有重要价值。IMpassion 130研究中，有关免疫学生物标志物亚组疗效评估的探索性分析显示，免疫细胞程序性死亡配体-1阳性表达者接受阿替利珠单克隆抗体联合白蛋白紫杉醇治疗后显著获益。PALLET研究结果显示，对绝经后早期的ER阳性、HER-2阴性乳腺癌患者使用新辅助内分泌治疗，来曲唑联合细胞周期蛋白依赖性激酶4/6抑制剂可显著提高Ki67抑制率，但未提高患者的临床缓解率。AERAS研究10年数据显示，阿那曲唑辅助内分泌治疗延长至10年组患者显著获益。EBCTCG Meta分析显示，延长内分泌治疗可显著降低绝经后的激素受体阳性乳腺癌患者的肿瘤复发风险。TAM-01研究结果提示，对于乳腺导管内廇变患者而言，低剂量他莫昔芬可能更具减毒、增效的优势。临床医师应积极推动新型药物的临床研究和生物预测标志物的探索性分析，充分发挥国内的优势，积极学习先进技术和理念，在临床治疗中使乳腺癌患者最大限度获益。

The 41st San Antonio Breast Cancer Symposium was held in San Antonio, Texas, USA on December 4-8, 2018. In this article, we reviewed the key advancement in breast cancer surgery, chemotherapy, targeted therapy, immunotherapy and endocrine therapy reported in this symposium, in order to provide references for clinicians in the treatment and research of breast cancer. The 10-year follow-up data of the EORTC AMAROS study suggested that axillary radiotherapy was a safe and feasible alternative to axillary lymph node dissection for primary breast cancer patients with positive axillary lymph nodes confirmed by sentinel lymph node biopsy. The result of the phase 3 GEICAM/CIBOMA study showed that in early triple negative breast cancer patients, capecitabine administration after surgery and standard chemotherapy did not significantly improve the patients’ survival. The meta-analysis conducted by researchers in Harvard University suggested that the patients who achieve pCR after neoadjuvant chemotherapy could be exempted from conventional adjuvant chemotherapy, with no obvious effect on patients’ survival. The multi-center PEONY study conducted by Professor Shao Zhimin in China showed that for neoadjuvant therapy of early or locally advanced HER-2 positive breast cancer patients in Asia, the overall postoperative pCR rate of double-target group (pertuzumab monoclonal antibody + trastuzumab monoclonal antibody + docetaxel) was significantly higher than that of single-target group (trastuzumab monoclonal antibody + docetaxel). The KATHERINE study showed that the trastuzumab monoclonal antibody combined with maitansine conjugate was feasible in the adjuvant treatment of HER-2 positive early breast cancer. An exploratory analysis to evaluate the efficacy of immuno-biomarker subgroups in the IMpassion 130 study showed that the patients with programmed death ligand 1 positive in immunocytes significantly benefited from the treatment of atezolizumab monoclonal antibody + albumin paclitaxel. The PALLET study showed that in postmenopausal early breast cancer patients with ER positive and HER-2 negative, the neoadjuvant endocrine therapy of letrozole combined with CDK4/6 inhibitors significantly increased the inhibition rate of Ki67, but did not improve the clinical response rate. The 10-year clinical data of the AERAS study showed that the patients significantly benefited from the adjuvant endocrine therapy if the use of anastrozole was extended to 10 years. The meta-analysis of EBCTCG showed that prolonged endocrine therapy significantly reduced the overall risk of recurrence in hormone receptor-positive postmenopausal breast cancer. The TAM-01 study suggested that low-dose administration of tamoxifen could reduce the toxicity and improve the efficacy in patients with breast intraductal neoplasms. The clinicians should actively promote the clinical research of new drugs and the exploratory analysis of predictive biomarkers, take the advantages of domestic researches and learn advanced techniques and concepts overseas in order to benefit most of breast cancer patients.