首页 中华肿瘤杂志 2023年45卷07期 中华医学会肺癌临床诊疗指南(2023版)
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中华医学会肺癌临床诊疗指南(2023版)
中华医学会肿瘤学分会 
中华医学会杂志社
作者及单位信息
·
DOI： 10.3760/cma.j.cn112152-20230510-00200
Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2023 edition)
Oncology Society of Chinese Medical Association
Chinese Medical Association Publishing House
Han Baohui
Wang Jie
Authors Info & Affiliations
Oncology Society of Chinese Medical Association
Chinese Medical Association Publishing House
Han Baohui
Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
Wang Jie
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
·
DOI： 10.3760/cma.j.cn112152-20230510-00200
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摘要
为进一步规范中国肺癌的防治措施、提高肺癌的诊疗水平、改善患者的预后、为各级临床医务人员提供专业的循证医学建议，中华医学会肿瘤学分会组织呼吸内科、肿瘤内科、胸外科、放疗科、影像科和病理科专家，经过共识会议制定了《中华医学会肺癌临床诊疗指南(2023版)》。2023版更新内容包括在筛查部分删除了根据高加索人群流调所确定的肺癌高危人群特征(长期重度吸烟)，保留基于中国人群流调确认的肺癌高危人群特征，并建议筛查机构通过完整的说明及介绍使筛查人群充分了解肺癌筛查的益处和局限性。病理部分在组织标本诊断原则中增加了4种神经内分泌肿瘤(典型类癌、不典型类癌、大细胞神经内分泌癌、小细胞肺癌)的病理特点。在外科部分，根据相关临床研究的结果(CALGB140503、JCOG0802、JCOG1211)，提出了对于部分外周型病灶可有更多的术式选择。在内科部分，更新内容包括免疫新辅助使得早中期非小细胞肺癌患者的预后大幅改善。在中晚期非小细胞肺癌的治疗中，放化疗后的免疫巩固有了更多的选择，晚期非小细胞肺癌常见的敏感突变基因如表皮生长因子受体突变、间变性淋巴瘤激酶融合和少见靶点如MET外显子14跳跃突变、RET融合、ROS1融合、NTRK融合等都有相应的药物相继获批，使得医师和患者有了更多的选择。此外，多个免疫检查点抑制剂在晚期非小细胞肺癌和小细胞肺癌的治疗中相继获批并写入指南，使得晚期肺癌患者的生存进一步得到了提高。指南以国家批准的应用指征为原则，以国内实际可应用的药品为基础，结合国际指南推荐意见和中国临床实践现状，整合近年来肺癌筛查、诊断、病理、基因检测、免疫分子标志物检测和治疗手段以及随访等诊治方面的最新循证医学证据，旨在为各级临床医师、影像、检验、康复等专业人员提供合理的推荐建议。
肺肿瘤;诊断;治疗;指南
ABSTRACT
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 Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer in China (2023 edition) 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.
Lung neoplasms;Diagnosis;Therapy;Guideline
Han Baohui, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China, Email: mocdef.nabuyilayykxnah;
Wang Jie, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China, Email: mocdef.3ab61ixuhlz
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引用本文
中华医学会肿瘤学分会,中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2023版)[J]. 中华肿瘤杂志,2023,45(07)：539-574.
DOI:10.3760/cma.j.cn112152-20230510-00200PERMISSIONS
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原发性支气管肺癌简称肺癌，是我国及世界各国发病率和死亡率较高的恶性肿瘤之一[
1
]。2022年中国的所有恶性肿瘤新发病例中肺癌排名第1位，占18.06%，而肺癌死亡人数占中国恶性肿瘤死亡总数的23.9%，同样排名第1位[
2
]。早期肺癌多无明显症状，临床上多数患者出现症状就诊时已属晚期，晚期肺癌患者整体5年生存率在20%左右[
3
]。
为进一步规范我国肺癌防治措施、提高肺癌诊疗水平、改善患者预后、为各级医师提供专业的循证医学建议，中华医学会肿瘤学分会组织呼吸内科、肿瘤内科、胸外科、放疗科、影像科和病理科专家，结合国际指南和中国国情，整合近年来肺癌诊治新进展，制定了《中华医学会肺癌临床诊疗指南(2023版)》，旨在为各级临床医师提供肺癌筛查、诊断、病理、治疗和随访等方面的循证医学证据和指导性建议。本指南根据循证医学级别进行了分类推荐(
表1
)。
| 推荐类别 | 循证医学证据级别 |
|---|---|
| 1类推荐证据 | 级别最高，专家组一致推荐 |
| 2A类推荐证据 | 级别稍低，专家组一致推荐 |
| 2B类推荐证据 | 级别低，部分专家推荐 |
| 3类推荐证据 | 专家分歧较大 |
展开表格
中华医学会肺癌临床诊疗指南循证医学推荐级别
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备注信息
A
韩宝惠，上海市胸科医院 上海交通大学医学院附属胸科医院呼吸内科，上海 200030，Email：mocdef.nabuyilayykxnah;
B
王洁，国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院内科，北京 100021，Email：mocdef.3ab61ixuhlz
C
本文同时发表在《中华医学杂志》2023年第103卷第27期2037-2074页
D
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