2023 NCCN V1围手术期诊断评估和治疗更新全文.docx

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1、2023NCCNV1围手术期诊断、评估和治疗更新（全文）近日，非小细胞肺癌（NSC1C）NCCNV1版更新，此版更新（对比2023V6版）针对早期和局部晚期NSC1C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NCCNNationa1ComprehensiveCancerNetwork*NCCNGuide1inesVersion1.2023Non-Sma11Ce111ungCancerNCCNGmctofcneBIndexTab1eofContentsDiscussionPRINCIP1ESOFDIAGNOSTICEVA1UATIONPatientswitha

2、strongc1inica1suspicion0mU90IAungcancer(basedonriskfactorsandradkkgicappearance)donotrequireabiopsybeforesurgery.Abiopsyaddstime,costs,andprocedura1riskandmaynotbneededfortreatmentdecisions.，ApreoperativbiopsymaybeappropriateHanonJungcancerdiagnosisisstrong1ysuspctedthatcanbediagnosedbycorebiopsyorf

3、iGd1aspiration(FNA1ttvbkpsymaybeusfu1forpatintsvvtthc1inica1stgIBorhigherwhomaybcandidatesforsystemictherapypriortoAprooperativobiopsymayboappropriaterfanIntraoperativodiagnosisappearsdifficu1torveryrisky?IfapreopratrvtissudiagnosishasnotboonobUind.thnanitrxprativdiagnosis(i.wdgrsction.nd1biopy)isne

4、cessary*preoperativebronchoscopymayaobepreferredfortiuedia90sand/ormediata1staging(endobronca1uttraound(EBUS).ITabronchoscopyhasnotbeenprevious1ypertornedtordiagnosisorstaging,bronchoscopyshou1dbeperformedduringthep1annedsurgica1resection,ratherthanasaseparateprocedure.Bronchoscopyisrequiredbeforesu

5、rgica1resection(NSCV2). AsparatbronchoscopymaynotbnMddfortreatmentdecisionsbforttimofsurgeryandaddstime,costs,andprocedura1risk. ApreoperativebronchoscopymaybeappropriateIfacentra1tumorrequirespre-reMctioneva1uationforbiopsy,surgica1p1anning(g.potentia1sgerMCtio),orproprativoairwaypropartion(g.corin

6、goutanobstructive1sion). Invasivomediastina1stagingisrecommendedbeforesurgica1resectionformostpatientswithc1inica1stageIorH1ungcancer(NSC12).FOfpatientsundergoingEBUSndoscopicu1trasound(EUS)staging,thismostcommon1yshou1dbasoparatproceduretoa11owpatho1ogicva1uation. Patientshavingmediastinoscopyshou1

7、dpreferab1yUndergOInvasivemediastina1staging(mediastinoscopy)astheinitia1stpbeforethep1annedresection(duringthesameanestheticprocedure),ratherthanasaseparateprocedure. aahpro6durdosiig.cost,drAAthotcr.idovo6d6.artandoaanestnttcr1iik. PreopQrativoinvasivemediastina1stagingmaybeappropriateforastrongCM

8、niS1suspicionofN2ocN3noda1disoaMorwhenintraoperativecyto1ogyorfrozensectionana1ysisisnotavai1ab1e.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

9、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。NSC1-1NSC1C的病理诊断、初始评估和临床分期Nationa1ComprehensiveCancerNetwork,NCCNGuide1inesVersion1.2023Non-Sma11Ce111ungCancerNCCNGUideIineS1ndeXTbe“COnteOtSDtcwonPATHO1OGICINI

10、TIA1EVA1UATIONDIAGNOSISOFNSC1CNSC1CPatho1ogyrovi。WaH&P(inc1udeperformancestatusweight1ott)bCTChMtandupperabdomenwithcontrast,inc1udingadrena1sCBC1p1ate1etsChemistryprofi1eSmokingcessationadvice,counso1ing,andpharmacotherapyUiethe5A,sFrarmwortcAsk,Advise.Assess.Assist.ArrangehttpWWWhrq.goWdin1c/tobac

11、co5steps.htmIntograto网HatiVOcrcNCCNGuide1inesforPa11iativoCaroFortoo1stoaidinth。optima1assessmentandmnagOmntofNSC1CIno1deradu1ts,seetheNCCNGuide1inesforO1derAdu1tOnCOIOqyC1inica1stageSta9eIA.POriPhor.2(T1abc.NO)StagoIB.POriPhorrd(T2,NO);StageI.centra14(T1abc-T2a.NO);StagoU(T1abc-T2b,N1;T2b.NO);Stage

12、IIB(T3.N0);StageIIIA(T3tN1)StageIIBr(T3invasion,NO);StageIIIAf(T4extension.NO-1;T3tN1;T4,NO-1)StageIIIAf(T1-ZN2);StageIIIB(T3tN2)Pretreatment副副UMiQn1NSCkaPretrMtmw1Eva1uation(NSC1-3)PwttwrtmentEvg1Mation(NSC1-S)PretreetmentEva1uation(NSC1)Mu1tip1e1ungSnCorSPrtr)Eya1uatiQn(NSGhJ1)Eva1uation(NSC1-13)P

13、retreatrMntEf1st1o(NSe33)StageIVA(M1b)cdPwttMttMf1tEvgIuMion(NSC1-14)StageIVB(M1c)cdisseminatedmetastasesSxfttfimicTbaaDy(NSC118)dBasedontheCTcrfIhecestPenphera1outerthrdof1ung;Centra1innertwo PnnaDieSo(PathotoycReVMyW(NSCH).bEnhancedfracu1artysurgeryApreferredfraMryassessmentsystemhasnotbeenestabit

14、sbedstagA(priphra1T1abc,No)。Tng悔nohMdGorderooorkdmdasnoscopy.mdstmofny.EBUS.EUS.andCTumMtrtopey.AnEBUSTBNAne9wIcxmfcgrncyS*9y(PETnd0fCT)pomvmdtMttnumshou1dUMer90sutaquntCCnnfmabOn1rrmm.&SUnKtfTTmcwy(NSC1-1neriskxIIKei1hoodofPOewvemedaMarymphnodeswhenthesenodesareCTandPETrwgavtnPenPMraituxx(outertrwdofIUng)mduMftna1vakMonisOpbona1m9wmsmngskwsvmeaMa*staging0recommendedforc