Zhonghua Yi Xue Za Zhi. 2023 Jul 18;103(27):2037-2074. doi: 10.3760/cma.j.cn112137-20230510-00767.
To standardize the prevention and clinical management of lung cancer, improve patients' survival outcomes, and offer professional insight for clinicians, the Oncology Society of Chinese Medical Association has summoned experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to formulate the through consensus meetings. Updates in this edition include 1) cancer screening: deletion of high-risk traits of lung cancer based on epidemiological investigations in the Caucasian population, while preserving features confirmed by research on the Chinese population. Advice on screening institutions is also added to raise awareness of the merits and demerits of lung cancer screening through detailed illustrations. 2) Principles of histopathologic evaluation: characteristics of four types of neuroendocrine tumors (typical carcinoid, atypical carcinoid, large cell carcinoma, and small cell carcinoma) are reviewed. 3) Surgical intervention: more options of resection are available for certain peripheral lesions based on several clinical studies (CALGB140503, JCOG0802, JCOG1211). 4) neoadjuvant/adjuvant therapy: marked improvement in the prognosis of non-small cell lung cancer (NSCLC) patients receiving neoadjuvant immunotherapy are reviewed; more options for consolidation immunotherapy after radiochemotherapy have also emerged. 5) Targeted and immune therapy: tyrosine kinase inhibitors of sensitive driver mutations such as EGFR and ALK as well as rare targets such as MET exon 14 skipping, RET fusion, ROS1 fusion, and NTRK fusion have been approved, offering more treatment options for clinicians and patients. Furthermore, multiple immune checkpoint inhibitors have been granted for the treatment of NSCLC and SCLC, resulting in prolonged survival of late-stage lung cancer patients. This guideline is established based on the current availability of domestically approved medications, recommendations of international guidelines, and present clinical practice in China as well as integration of the latest medical evidence of pathology, genetic testing, immune molecular biomarker detection, and treatment methods of lung cancer in recent years, to provide recommendations for professionals in clinical oncology, radiology, laboratory, and rehabilitation.
为规范肺癌的预防与临床管理，改善患者生存结局，并为临床医生提供专业见解，中华医学会肿瘤学分会召集了呼吸内科、肿瘤内科、胸外科、放疗科、影像科及病理科专家，通过共识会议制定了本指南。本版更新内容包括：1）癌症筛查：基于白种人群流行病学调查删除了肺癌高危特征，同时保留了中国人群研究证实的特征。还增加了对筛查机构的建议，通过详细说明提高对肺癌筛查利弊的认识。2）组织病理学评估原则：回顾了四种神经内分泌肿瘤（典型类癌、非典型类癌、大细胞癌和小细胞癌）的特征。3）手术干预：基于多项临床研究（CALGB140503、JCOG0802、JCOG1211），某些周围性病变有了更多的切除选择。4）新辅助/辅助治疗：回顾了接受新辅助免疫治疗的非小细胞肺癌（NSCLC）患者预后的显著改善；放化疗后巩固免疫治疗也出现了更多选择。5）靶向和免疫治疗：已批准针对敏感驱动基因突变（如EGFR和ALK）以及罕见靶点（如MET外显子14跳跃、RET融合、ROS1融合和NTRK融合）的酪氨酸激酶抑制剂，为临床医生和患者提供了更多治疗选择。此外，多种免疫检查点抑制剂已获批用于治疗NSCLC和SCLC，延长了晚期肺癌患者的生存期。本指南基于国内已批准药物的现状、国际指南的建议、中国目前的临床实践以及近年来肺癌病理、基因检测、免疫分子生物标志物检测和治疗方法的最新医学证据制定，为临床肿瘤学、放射学、实验室和康复领域的专业人员提供建议。
