中国胆道恶性肿瘤诊断和治疗临床实践指南。
Chinese national clinical practice guideline on diagnosis and treatment of biliary tract cancers.
机构信息
Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Systems Medicine for Cancers, Shanghai Cancer Institute; Shanghai Key Laboratory for Cancer Systems Regulation and Clinical Translation, Shanghai 200127, China.
Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
出版信息
Chin Med J (Engl). 2024 Oct 5;137(19):2272-2293. doi: 10.1097/CM9.0000000000003258. Epub 2024 Sep 4.
BACKGROUND
Biliary tract carcinoma (BTC) is relatively rare and comprises a spectrum of invasive tumors arising from the biliary tree. The prognosis is extremely poor. The incidence of BTC is relatively high in Asian countries, and a high number of cases are diagnosed annually in China owing to the large population. Therefore, it is necessary to clarify the epidemiology and high-risk factors for BTC in China. The signs associated with BTC are complex, often require collaborative treatment from surgeons, endoscopists, oncologists, and radiation therapists. Thus, it is necessary to develop a comprehensive Chinese guideline for BTC.
METHODS
This clinical practice guideline (CPG) was developed following the process recommended by the World Health Organization. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of evidence and make recommendations. The full CPG report was reviewed by external guideline methodologists and clinicians with no direct involvement in the development of this CPG. Two guideline reporting checklists have been adhered to: Appraisal of Guidelines for Research and Evaluation (AGREE) and Reporting Items for practice Guidelines in Healthcare (RIGHT).
RESULTS
The guideline development group, which comprised 85 multidisciplinary clinical experts across China. After a controversies conference, 17 clinical questions concerning the prevention, diagnosis, and treatment of BTC were proposed. Additionally, detailed descriptions of the surgical principles, perioperative management, chemotherapy, immunotherapy, targeted therapy, radiotherapy, and endoscopic management were proposed.
CONCLUSIONS
The guideline development group created a comprehensive Chinese guideline for the diagnosis and treatment of BTC, covering various aspects of epidemiology, diagnosis, and treatment. The 17 clinical questions have important reference value for the management of BTC.
背景
胆道癌（BTC）相对罕见，由胆管树中发生的一系列侵袭性肿瘤组成。预后极差。亚洲国家的 BTC 发病率相对较高，由于人口众多，中国每年诊断出的病例数量也很多。因此，有必要阐明中国 BTC 的流行病学和高危因素。BTC 的症状较为复杂，往往需要外科医生、内镜医生、肿瘤学家和放射治疗师共同治疗。因此，有必要制定一个全面的中国 BTC 指南。
方法
本临床实践指南（CPG）是按照世界卫生组织推荐的流程制定的。采用推荐评估、制定和评估方法（Grading of Recommendations Assessment, Development, and Evaluation approach）评估证据的确定性并提出建议。外部指南方法学家和临床医生对完整的 CPG 报告进行了审查，他们没有直接参与本 CPG 的制定。我们遵循了两个指南报告清单：评估研究和评估指南（Appraisal of Guidelines for Research and Evaluation，AGREE）和医疗保健实践指南报告项目（Reporting Items for practice Guidelines in Healthcare，RIGHT）。
结果
指南制定小组由中国 85 名多学科临床专家组成。在争议会议之后，提出了 17 个关于 BTC 预防、诊断和治疗的临床问题。此外，还详细描述了手术原则、围手术期管理、化疗、免疫治疗、靶向治疗、放疗和内镜治疗。
结论
指南制定小组制定了一个全面的中国 BTC 诊断和治疗指南，涵盖了流行病学、诊断和治疗的各个方面。这 17 个临床问题对 BTC 的管理具有重要的参考价值。
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