Page 35 - 《南京医科大学学报（自然科学版）》2026年第3期
P. 35
第46卷第3期 南京医科大学学报（自然科学版）
2026年3月 Journal of Nanjing Medical University（Natural Sciences） ·343 ·
·专题研究：肿瘤·
从代谢与免疫视角解析乳腺癌肿瘤微环境：精准医学的挑战与
机遇
刘进宇，段佳文，张志生 *
河北北方学院附属第一医院乳腺外科，河北 张家口 075000
［摘 要］ 乳腺癌作为全球女性最常见的恶性肿瘤，其治疗面临长期预后较差的挑战，尽管近年来乳腺癌患者5年生存率已
显著提升，但三阴性乳腺癌等特定亚型的疗效仍有待突破。文章从代谢与免疫视角深入探讨了乳腺癌微环境的复杂机制，指
出代谢重编程和免疫逃逸在乳腺癌进展中的关键作用，其中肿瘤细胞通过Warburg效应产生大量乳酸，不仅为自身增殖提供
能量，还通过酸化微环境抑制T细胞和NK细胞的抗肿瘤活性。不同亚型乳腺癌在代谢和免疫特征上表现出显著差异，为精准
医学提供了新视角。文章分析了乳腺癌肿瘤微环境中的代谢与免疫互作网络，强调了乳酸、脂质代谢产物等在免疫抑制中的
作用，讨论了精准医学在乳腺癌治疗中因患者异质性和生物标志物开发不足带来的挑战。文章探讨了乳腺癌肿瘤微环境中的
分子机制，分析了精准医学面临的关键问题，并展望了未来可能的研究方向和治疗策略。
［关键词］ 乳腺癌；肿瘤微环境；精准医学；肿瘤代谢；免疫系统
［中图分类号］ R737.9 ［文献标志码］ A ［文章编号］ 1007⁃4368（2026）03⁃343⁃12
doi：10.7655/NYDXBNSN250567
Deciphering the tumor microenvironment of breast cancer from metabolic and
immunological perspectives：challenges and opportunities in precision medicine
LIU Jinyu，DUAN Jiawen，ZHANG Zhisheng *
Department of Breast Surgery，the First Affiliated Hospital of Hebei North University，Zhangjiakou 075000，China
［Abstract］ As a malignant neoplasm exhibiting the highest global incidence among women，breast cancer continues to present
significant therapeutic challenges despite markedly enhanced 5⁃year survival rates. Notably，treatment efficacy for aggressive subtypes
such as triple⁃negative breast cancer remains suboptimal. This comprehensive review elucidates the intricate mechanisms within the
breast tumor microenvironment（TME） through integrated metabolic and immunological perspectives，establishing metabolic
reprogramming and immune evasion as fundamental drivers of disease progression. Tumor cells execute Warburg effect ⁃ mediated
lactate overproduction，simultaneously fueling proliferative demands while acidifying the microenvironment to suppress anti ⁃ tumor
activity of T cells and NK cells. Substantial heterogeneity in metabolic and immune signatures across molecular subtypes creates new
paradigms for precision oncology. Our analysis delineates the metabolic⁃immune crosstalk network within breast TME，emphasizing the
immunosuppressive roles of lactate and lipid metabolites. We critically examine translational barriers in precision medicine
implementation，particularly addressing unresolved challenges of patient heterogeneity and underdeveloped biomarkers. By
systematically exploring TME molecular mechanisms，identifying precision medicine limitations，and projecting future therapeutic
trajectories，this review establishes a framework for overcoming current treatment impasses through innovations in combinatorial
targeting，predictive modeling，and biomarker discovery.
［Key words］ breast cancer；tumor microenvironment；precision medicine；tumor metabolism；immune system
［J Nanjing Med Univ，2026，46（03）：343⁃354］
［基金项目］ 河北省卫计委医学科学研究重点课题（20231418）
通信作者（Corresponding author），E⁃mail：bfyfyzzs@163.com（ORCID：0009⁃0001⁃3781⁃314X）
∗
