中国县域肺癌临床诊疗路径(2024版)  

The clinical pathway in China county for lung cancer diagnosis and treatment(2024 edition)

作　　者：中国胸部肿瘤研究协作组 健康中国研究中心癌症防治专家委员会 广东省医师协会临床试验专业委员会 周清[2] 吴一龙 Chinese Thoracic Oncology Group;Cancer Prevention and Treatment Committee of Healthy China Research Center;Guangdong Provincial Medical Association Clinical Trial Professional Committee;Zhou Qing;Wu Yilong(不详;Guangdong Lung Cancer Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]不详 [2]广东省人民医院肿瘤医院,南方医科大学附属广东省人民医院(广东省医学科学院),广州510080 [3]广东省肺癌研究所,南方医科大学附属广东省人民医院(广东省医学科学院),广州510080

出　　处：《中华肿瘤杂志》2025年第1期1-25,共25页Chinese Journal of Oncology

基　　金：四大慢病重大专项(2023ZD0501700);广东省科技计划项目(2023B110009);教育部“长江学者”特聘教授配套经费(KY0120240205)。

摘　　要：规范肺癌诊疗是提升肺癌患者生存率、降低死亡率的关键措施。目前县域医院依然普遍面临先进医疗技术和设备不可及的困境,因此,在制定肺癌质控标准和临床诊疗规范时,必须结合县域医院的特色与实际情况,出具系统的可落地的标准流程和指导措施。同时,药物治疗方案的推荐还需要考虑适应证获批情况以及是否纳入《国家基本医疗保险、工伤保险和生育保险药品目录》,以确保药物的可及性。为了解决上述问题,基于国内外现有指南和县域医院的临床工作特点,更新了《中国县域肺癌临床诊疗路径(2024版)》(以下简称《路径》)。《路径》详细阐述了肺癌的影像和分期诊断、病理学诊断、分子分型,以及精准治疗,并针对不同类型的肺癌患者制定了不同的管理与诊治流程。将临床场景的诊治推荐分为基本策略和可选策略进行阐述。基本策略是县域医院必须达到的最低诊疗标准,而可选策略则为医院提供了更多的选择,方便县域医师参考使用。所有的诊疗方案推荐严格参照国内外最新指南和共识,确保了准确性、科学性和客观性。与2023版比较,基于最新的高级别循证医学证据及适应证获批情况,2024版《路径》系统更新了基本策略和可选策略中不同病理类型、分期和分子分型下肺癌的诊治推荐。Standardizing the diagnosis and treatment of lung cancer is a key measure to improve the survival rate of lung cancer patients and reduce the mortality rate.However,county hospitals generally face the problem of inaccessibility to advanced diagnostic and treatment technologies.Therefore,when developing quality control standards and clinical diagnosis and treatment specifications,it is necessary to combine the actual situation of county hospitals and formulate specific recommendations.The recommendations of treatment measures also need to consider the approval status of indications and whether it is included in the National Reimbursement Drug List(NRDL),to ensure the access to medicines.To address the above issues,based on the existing guidelines at home and abroad and the clinical work characteristics of county hospitals,the"the clinical pathway in China county for lung cancer diagnosis and treatment(2024 edition)"has been updated on the basis of the first edition.This pathway elaborated on the imaging diagnosis,pathological diagnosis,molecular testing,precision medicine,and developed different diagnosis and treatment processes for different types of lung cancer patients.Consistent with the first pathway,this update still divides the recommendations for diagnosis and treatment of clinical scenarios into basic strategies and optional strategies for elaboration.The basic strategies are the standards that county hospitals must meet,while the optional strategies provide more choices for hospitals,which are convenient for county doctors to put into clinical practice.All the recommended diagnostic and treatment plans strictly refer to existing guidelines and consensus.Compared to the first edition,based on the latest high-level evidence-based medicine and the approval status of indications,the pathway has updated the diagnosis and treatment recommendations for lung cancer under different pathological types,TNM classification,and molecular classification in basic and optional strategies.

关 键 词：肺肿瘤 临床诊疗路径 基本策略 可选策略 县域 

分 类 号：R73[医药卫生—肿瘤]