Blum Torsten Gerriet, Morgan Rebecca L, Durieux Valérie, Chorostowska-Wynimko Joanna, Baldwin David R, Boyd Jeanette, Faivre-Finn Corinne, Galateau-Salle Françoise, Gamarra Fernando, Grigoriu Bogdan, Hardavella Georgia, Hauptmann Michael, Jakobsen Erik, Jovanovic Dragana, Knaut Paul, Massard Gilbert, McPhelim John, Meert Anne-Pascale, Milroy Robert, Muhr Riccardo, Mutti Luciano, Paesmans Marianne, Powell Pippa, Putora Paul Martin, Rawlinson Janette, Rich Anna L, Rigau David, de Ruysscher Dirk, Sculier Jean-Paul, Schepereel Arnaud, Subotic Dragan, Van Schil Paul, Tonia Thomy, Williams Clare, Berghmans Thierry
Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Eur Respir J. 2023 Feb 16;61(2). doi: 10.1183/13993003.03201-2021. Print 2023 Feb.
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
本欧洲呼吸学会指南致力于在肺癌护理方面提供高质量的建议。所有包含的临床建议均基于全面的系统评价以及针对八个PICO（患者、干预措施、对照、结局）问题的证据综合分析。证据按照GRADE（推荐分级的评估、制定与评价）方法进行评估。使用证据概况和GRADE证据到决策框架来总结结果，并使决策过程透明化。一个由肺癌专家组成的多学科特别工作组在对系统评价结果进行深入讨论后制定并认可了这些临床建议。具体而言，我们针对以下被认为适用于常规肺癌护理的质量改进措施提出了建议：1）避免诊断和治疗期的延误；2）整合多学科团队和多学科会诊；3）实施并遵循肺癌指南；4）肺癌手术及其他操作中机构/个人高容量和高级专业化的益处；5）肺部病变且疑似肺癌患者的病变需病理确诊，以及确诊肺癌的可操作靶点或治疗反应的组织学亚型分类和分子特征分析；6）早期整合姑息治疗团队或专家的附加价值；7）整合特定质量改进措施的优势；8）使用患者决策工具的益处。如有新证据出现，这些建议应酌情重新考虑并更新。
