【作者】
倪军；
黄淼；
张力；
吴楠；
白春学；
陈良安；
梁军；
刘谦；
王洁；
吴一龙；
张奉春；
张抒扬；
陈椿；
陈军；
方文涛；
高树庚；
胡坚；
姜涛；
李单青；
李鹤成；
廖永德；
刘阳；
刘德若；
刘宏旭；
刘建阳；
刘伦旭；
王孟昭；
王长利；
杨帆；
杨跃；
张兰军；
支修益；
钟文昭；
管宇宙；
郭潇潇；
何春霞；
李少雷；
李玥；
梁乃新；
鲁方亮；
吕超；
吕玮；
斯晓燕；
谭锋维；
王汉萍；
王江山；
阎石；
杨华夏；
朱惠娟；
庄俊玲；
卓明磊；
【Author】
Jun NI;Miao HUANG;Li ZHANG;Nan WU;Chunxue BAI;Liang’an CHEN;Jun LIANG;Qian LIU;Jie WANG;Yilong WU;Fengchun ZHANG;Shuyang ZHANG;Chun CHEN;Jun CHEN;Wentao FANG;Shugeng GAO;Jian HU;Tao JIANG;Shanqing LI;Hecheng LI;Yongde LIAO;Yang LIU;Deruo LIU;Hongxu LIU;Jianyang LIU;Lunxu LIU;Mengzhao WANG;Changli WANG;Fan YANG;Yue YANG;Lanjun ZHANG;Xiuyi ZHI;Wenzhao ZHONG;Yuzhou GUAN;Xiaoxiao GUO;Chunxia HE;Shaolei LI;Yue LI;Naixin LIANG;Fangliang LU;Chao LV;Wei LV;Xiaoyan SI;Fengwei TAN;Hanping WANG;Jiangshan WANG;Shi YAN;Huaxia YANG;Huijuan ZHU;Junling ZHUANG;Minglei ZHUO;Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College;Department of Thoracic Surgery, Peking University Cancer Hospital;Department of Pulmonary Medicine,Zhongshan Hospital, Fudan University;The First Medical Center of Chinese PLA General Hospital;Peking University International Hospital;Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital;State Key Laboratory of Molecular Oncology, National Cancer Center,National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College;Department of Pulmonary Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences;Department of Thoracic Surgery, Fujian Medical University Union Hospital;Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute;Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University;Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine;Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University;Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine;Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology;China-Japan Friendship Hospital;Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute;Department of Thoracic Surgery-1, Jilin Cancer Hospital;Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University;Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer;Peking University People’s Hospital;Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center;Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University;
【通讯作者】
张力;吴楠;
【机构】
中国医学科学院北京协和医院；
北京大学肿瘤医院；
复旦大学呼吸病研究所；
中国人民解放军总医院；
北京大学国际医院；
天津医科大学总医院天津市肺癌研究所；
中国医学科学院肿瘤医院；
广东省人民医院；
福建医科大学附属协和医院；
天津医科大学总医院；
上海市胸科医院；
浙江大学医学院附属第一医院；
空军军医大学第二附属医院(唐都医院)；
上海交通大学医学院附属瑞金医院；
华中科技大学同济医学院附属协和医院；
中日友好医院；
中国医科大学肿瘤医院辽宁省肿瘤医院；
吉林省肿瘤医院；
四川大学华西医院；
天津医科大学附属肿瘤医院；
北京大学人民医院；
中山大学附属肿瘤医院；
首都医科大学宣武医院；
【摘要】 背景与目的肺癌围手术期治疗(术前新辅助治疗及术后辅助治疗)作为手术的重要辅助手段,已成为非小细胞肺癌(non-small cell lung cancer, NSCLC)全程管理中越来越重要的环节。近年来,小规模临床研究发现免疫新辅助治疗主要病理缓解率明显提升,甚至达到完全病理缓解,有望成为NSCLC治疗的重要组成部分。然而,免疫新辅助治疗带来疗效和生存获益,同时,其相关严重不良反应(延误手术、丧失手术机会、死亡等)备受关注。本诊疗建议目的是针对免疫检查点抑制剂相关不良反应(immune-related adverse event, irAE)形成适合国内医疗现状的诊疗方案。方法本文由胸外科专家、肿瘤学专家、胸内科专家以及irAE相关科室专家(消化内科、呼吸内科、心血管内科、感染内科、血液内科、内分泌科、风湿免疫科、神经内科、皮肤科和急诊科)共同完成本诊疗意见的制定工作。专家充分参考irAE指南、胸外科公开发表的大型临床研究数据以及国内医生的临床实战经验和公开发表个案,多学科反复讨论,形成针对围手术期免疫治疗相关不良反应的诊疗建议。结果本诊疗意见涵盖irAE相关的预防、评估、检查、治疗和监测全过程,以便全面、有效的指导临床工作。结论围手术期irAE管理是肺癌免疫围手术期治疗的重要组成部分,随着免疫围手术期治疗的不断发展,未来需要更多的研究,以优化围手术irAE的诊疗。更多还原
【Abstract】 Background and objective Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer(NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event(irAE). Methods This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments(gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. Results This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. Conclusion Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.更多还原
