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《中国医学协会肺癌临床诊疗指南(2024年版)》

[Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition)].

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Sep 3;104(34):3175-3213. doi: 10.3760/cma.j.cn112137-20240511-01092.

Abstract

To further standardize lung cancer prevention and treatment measures in China, enhance the quality of diagnosis and treatment, improve patient prognosis, and provide evidence-based medical guidance for clinicians at all levels, the Chinese Medical Association convened experts from respiratory medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to develop the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition). This consensus resulted in several updates from the 2023 edition. The 2024 guidelines highlight that the risk of lung cancer in smokers remains higher than that of non-smokers even 15 years after quitting. Additionally, a new lung cancer incidence risk model is expected to become a critical tool for screening high-risk groups. In pathology, the guidelines now include pathological evaluation of surgically resected lung cancer specimens following neoadjuvant therapy and suggest that immunohistochemical staining of certain transcription factors may aid in the classification of small cell lung cancer (SCLC). In molecular detection, the guidelines propose simultaneous detection of driver gene variations based on both RNA and DNA from specimens. The new edition also provides detailed descriptions of patient selection and surgical requirements for thoracic sub-lobectomy, aligned with the 9th TNM staging. Moreover, the guidelines expand treatment options, approving more therapies for immunoadjuvant and EGFR-TKI resistant lung cancer patients, as well as additional drug options for advanced non-small cell lung cancer (NSCLC) patients with EGFR mutations, EGFR 20 insertions, ALK fusions, and MET exon 14 skipping. These recommendations are based on state-approved drug applications, international guidelines, and current clinical practices in China, integrating the latest evidence-based medical research in screening, diagnosis, pathology, genetic testing, immune molecular marker detection, treatment methods, and follow-up care. The goal is to provide comprehensive and reasonable recommendations for clinicians, imaging specialists, laboratory technicians, rehabilitation professionals, and other medical staff at all levels.

摘要

为进一步规范我国肺癌防治措施,提高诊疗质量,改善患者预后,为各级临床医生提供循证医学指导,中华医学会召集呼吸内科、肿瘤内科、胸外科、放疗科、影像科及病理科专家制定了《中国临床肿瘤学会(CSCO)非小细胞肺癌诊疗指南(2024年版)》。本共识相较于2023年版有多项更新。2024年版指南强调,吸烟者即便戒烟15年后患肺癌的风险仍高于不吸烟者。此外,一种新的肺癌发病风险模型有望成为筛查高危人群的关键工具。在病理学方面,指南现纳入了新辅助治疗后手术切除肺癌标本的病理评估,并指出某些转录因子的免疫组化染色可能有助于小细胞肺癌(SCLC)的分类。在分子检测方面,指南建议同时基于标本的RNA和DNA检测驱动基因变异。新版还详细描述了肺叶亚切除的患者选择及手术要求,与第9版TNM分期一致。此外指南扩大了治疗选择,批准了更多用于免疫辅助和EGFR-TKI耐药肺癌患者的治疗方法,以及用于EGFR突变、EGFR 20插入、ALK融合和MET外显子14跳跃的晚期非小细胞肺癌(NSCLC)患者的更多药物选择。这些推荐基于国家批准的药物应用、国际指南以及我国当前临床实践,整合了筛查、诊断、病理、基因检测、免疫分子标志物检测、治疗方法及随访等方面最新的循证医学研究。目标是为各级临床医生、影像专家、检验技师、康复专业人员及其他医务人员提供全面且合理的建议。

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