2023 NCCN V1围手术期诊断、评估和治疗更新（全文）.docx

2023NCCNV1围手术期诊断、评估和治疗更新（全文）近日，非小细胞肺癌（NSCLC）NCCNV1版更新，此版更新（对比2022V6版）针对早期和局部晚期NSCLC的诊断、治疗等领域进行了大篇幅的更新。详情如下：DIAG-A1/3诊断评估原则NCCNNationalComprehensive Cancer Network*NCCNGuidelines Version 1.2023Non-Small Cell Lung CancerNCCNGmctofcneB IndexTable of Contents DiscussionPRINCIPLESOFDIAGNOSTICEVALUATIONPatientswithastrongclinicalsuspicion0mU90IAungcancer(basedonriskfactorsandradk>k>gicappearance)donotrequireabiopsybeforesurgery.Abiopsyaddstime,costs,andproceduralriskandmaynotbneededfortreatmentdecisions.，ApreoperativbiopsymaybeappropriateHanonJungcancerdiagnosisisstronglysuspctedthatcanbediagnosedbycorebiopsyorfiGdlaspiration(FNALttvbk>psymaybeusfulforpatintsvvtthclinicalstgIBorhigherwhomaybcandidatesforsystemictherapypriorto»AprooperativobiopsymayboappropriaterfanIntraoperativodiagnosisappearsdifficultorveryrisky?IfapreopratrvtissudiagnosishasnotboonobUind.thnanitrx>prativdiagnosis(i.wdgrsction.ndlbiopy)isnecessary*preoperativebronchoscopymayaobepreferredfortiuedia90sand/ormediatalstaging(endobroncaluttraound(EBUS).ITabronchoscopyhasnotbeenpreviouslypertornedtordiagnosisorstaging,bronchoscopyshouldbeperformedduringtheplannedsurgicalresection,ratherthanasaseparateprocedure.»Bronchoscopyisrequiredbeforesurgicalresection(NSCV2). AsparatbronchoscopymaynotbnMddfortreatmentdecisionsbforttimofsurgeryandaddstime,costs,andproceduralrisk. ApreoperativebronchoscopymaybeappropriateIfacentraltumorrequirespre-reMctionevaluationforbiopsy,surgicalplanning(g.potentialsgerMCtio),orproprativoairwaypropartion(g.coringoutanobstructivelsion). InvasivomediastinalstagingisrecommendedbeforesurgicalresectionformostpatientswithclinicalstageIorHlungcancer(NSCL2).FOfpatientsundergoingEBUSndoscopicultrasound(EUS)staging,thismostcommonlyshouldbasoparatproceduretoallowpathologicvaluation. PatientshavingmediastinoscopyshouldpreferablyUndergOInvasivemediastinalstaging(mediastinoscopy)astheinitialstpbeforetheplannedresection(duringthesameanestheticprocedure),ratherthanasaseparateprocedure. aahpro£6durdosiig.cost,drAAthotcr.idovo6d6.artand>oaanestnttcrliik. PreopQrativoinvasivemediastinalstagingmaybeappropriateforastrongCMniSlsuspicionofN2ocN3nodaldisoaMorwhenintraoperativecytologyorfrozensectionanalysisisnotavailable.修改第1点：临床强烈怀疑（由I或改为）IA期肺癌患者（基于危险因素和放射学表现）手术前不需要组织活检。新增第3行描述：术前活检可能对IB期或以上患者更有价值，这部分患者可能是术前全身治疗的适合人群。新增第2点：术前支气管镜检查也可能是组织诊断和/或纵隔分期（超声支气管镜EBUS）的首选。修改第3点：如果先前未通过支气管镜检查进行诊断或分期，（优选改为应）应在计划手术切除期间进行支气管镜检查，而不是单独进行。修改并移至第4点：对于大多数I或II期肺癌患者，建议在手术切除前进行侵入性纵隔分期。对于接受EBUS/超声内镜（EUS）进行分期的患者，通常应单独操作以进行评估。修改第1行描述：在计划切除之前，应首选侵入性纵隔分期（纵隔镜检查）作为初始选择（同一麻醉过程），不应单独进行。NSCL-1NSCLC的病理诊断、初始评估和临床分期NationalComprehensive Cancer Network,NCCNGuidelines Version 1.2023Non-Small Cell Lung CancerNCCNGUideIineSlndeX Tbe “ COnteOtS DtcwonPATHOLOGICINITIAL EVALUATION DIAGNOSISOF NSCLCNSCLCPathologyrovi。Wa H&P (include performance status weight lott)b CT ChMt and upper abdomen with contrast, including adrenals CBC1 platelets Chemistry profile Smoking cessation advice, counsoling, and pharmacotherapy > Uie the 5 A,s Frarmwortc Ask, Advise. Assess. Assist. Arrange http WWWhrq .goWdinlc/ tobacco5steps.htmIntograto 网HatiVO crc NCCN Guidelines forPalliativo CaroFor tools to aid in th。 optimal assessment and mnagOmnt of NSCLC In older adults, see the NCCN Guidelines for Older Adult OnCOIOqyClinicalstageSta9eIA. POriPhor.2 (T1abc. NO) Stago IB. POriPhorrd (T2, NO);Stage I. central4 (T1abc-T2a. NO); Stago U (T1abc-T2b, N1; T2b. NO);Stage IIB (T3. N0); Stage IIIA (T3t N1)Stage IIBr (T3 invasion, NO);Stage IIIAf (T4 extension. NO-1; T3t N1;T4, NO-1)Stage IIIAf (Tl-Z N2); Stage IIIB (T3t N2)Pretreatment副副 UMiQnlNSCkaPretrMtmwlEvaluation (NSCL-3)PwttwrtmentEvglMation (NSCL-S)PretreetmentEvaluation (NSCL)Multiplelung SnCorSPrtr<tmftEvaIMon(NSCLW)StageIIIBf (T1- N3); Stage IIIC (T3t N3)Stage IIIBf (T4. N2); Stog IIIC (T4, N3)Stage IVA (MIa)C (ptoural or pericardial effu¾k>)EyaluatiQn(NSGhJl)Evaluation(NSCL-13)PretreatrMntEflstlo (NSe3 3)StageIVA(M1b)cdPwttMttMfltEvgIuMion (NSCL-14)StageIVB (M1c)c disseminated metastasesSxfttfimicTbaaDy(NSCL 18)dBased on the CTcrfIhe cest Penpheral outer thrd of lung; Central« inner two PnnaDieSo(PathotoycReVMyW(NSCH).bEnhancedfra<tyOfgeratncasses5m0ntsmaypredictCompbcabonsbetterfo(Mmgtreatmentmodames.part>culartysurgeryApreferredfraMryassessmentsystemhasnotbeenestabitsbedstagA(priphral T1abc, No)。Tng悔 no< hMd G order o< Pbodty and dependent on dhH rcumtuoe, mntut>o<w pcoctss. and judtos uw Ot mourcsh Methods tor valudt>o rk>d mdasnoscopy. mdstmofny. EBUS. EUS. and CTumM trtopey. An EBUSTBNA ne9w Icx mfcgrncy S *9y (PET nd0f CT) pomv mdtMttnum should UMer90 sutaquntCCnnfmabOn1rrmm. & SUnK