Ni Jun, Huang Miao, Zhang Li, Wu Nan, Bai Chunxue, Chen Liang'an, Liang Jun, Liu Qian, Wang Jie, Wu Yilong, Zhang Fengchun, Zhang Shuyang, Chen Chun, Chen Jun, Fang Wentao, Gao Shugeng, Hu Jian, Jiang Tao, Li Shanqing, Li Hecheng, Liao Yongde, Liu Yang, Liu Deruo, Liu Hongxu, Liu Jianyang, Liu Lunxu, Wang Mengzhao, Wang Changli, Yang Fan, Yang Yue, Zhang Lanjun, Zhi Xiuyi, Zhong Wenzhao, Guan Yuzhou, Guo Xiaoxiao, He Chunxia, Li Shaolei, Li Yue, Liang Naixin, Lu Fangliang, Lv Chao, Lv Wei, Si Xiaoyan, Tan Fengwei, Wang Hanping, Wang Jiangshan, Yan Shi, Yang Huaxia, Zhu Huijuan, Zhuang Junling, Zhuo Minglei
Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China.
Department of Thoracic Surgery, Peking University Cancer Hospital, Beijing 100142, China.
Zhongguo Fei Ai Za Zhi. 2021 Mar 20;24(3):141-160. doi: 10.3779/j.issn.1009-3419.2021.101.06.
Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE).
This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE.
This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively.
Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.
围手术期治疗已成为非小细胞肺癌（NSCLC）患者管理中日益重要的一个方面。近年来开展的小规模临床研究显示，新辅助治疗后的主要病理缓解率有所提高，这表明它很快将成为NSCLC治疗的重要组成部分。然而，新辅助免疫治疗可能伴有严重不良反应，导致手术延迟或取消、额外疾病甚至死亡，因此备受关注。本临床建议的目的是针对免疫相关不良事件（irAE）形成适合当前国内医疗情况的诊断和治疗方案。
本建议由胸外科专家、肿瘤学家、胸内科医生以及与irAE相关科室（胃肠病学、呼吸病学、心脏病学、传染病学、血液学、内分泌学、风湿病学、神经病学、皮肤病学、急诊科）的专家共同完成制定。专家们充分参考了irAE指南、胸外科发表的大规模临床研究数据以及国内医生的临床经验和公开报道的病例，并经过多学科反复讨论，形成了这份关于围手术期irAE的建议。
本临床建议涵盖了与irAE相关的预防、评估、检查、治疗及监测的全过程，从而全面、有效地指导临床工作。
围手术期irAE管理是肺癌免疫围手术期治疗的重要组成部分。随着免疫围手术期治疗的不断发展，未来需要更多研究来优化围手术期irAE的诊断和治疗。
