胃癌是全球范围内高发恶性肿瘤,具有高度侵袭性,总体预后不佳等特点。东西方胃癌人群在流行病学、临床病理学特征、治疗模式及药物选择等方面存在差异。近年来,随着靶向治疗和免疫治疗的快速推进,精准治疗理念的成熟和多学科治疗的推广等,临床研究成果不断更新,胃癌指南每年持续更新,以适应不断变化的诊疗需求。本文就全球范围内三大权威胃癌指南最新版[包括美国国家综合癌症网络(National Comprehensive Cancer Network,NCCN)胃癌临床实践指南2024年V5版(2024年12月发布)、欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)胃癌在线指南2024版(2024年9月发布)和中国临床肿瘤协会(Chinese Society of Clinical Oncology,CSCO)胃癌诊疗指南(2024年4月发布)]更新内容的异同点进行对比与梳理,聚焦不可手术切除的局部晚期或转移性食管胃结合部和胃腺癌的临床治疗策略,关注基于靶点如人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)、程序性死亡受体配体1(programmed death-ligand 1,PDL1)表达、错配修复蛋白(mismatch repair,MMR)状态和新靶点如Claudin18.2(CLDN18.2)等为导向的抗肿瘤药物的精准实施和全程管理。其中,HER2阳性晚期胃癌进入全线抗HER2治疗时代,抗HER2的抗体药物偶联物(antibody-drug conjugate,ADC)成为一线曲妥珠单抗治疗耐药之后的新选择。除此之外,免疫治疗联合化疗成为晚期胃癌一线治疗新标准,基于MMR状态和PD-L1表达指导的诊疗模式将免疫治疗推向精准化,然而目前PD-L1表达检测在临床推广和执行的过程中仍存在一定困难。2024年发表的三大指南融合了最新的临床研究结果、药物适应证的获批情况和医疗保健系统的实情等内容,尤其是CSCO胃癌指南基于中国自主研发药物的快速发展和针对中国人群研究适应证的成功获批进行了更新。三大指南在靶向治疗、免疫疗
According to the latest global cancer statistics,colorectal cancer(CRC)is the most common malignancy of the digestive system and the second most lethal among all cancer types(1).In China,CRC is the second most prevalent cancer,following only after lung cancer(2).The first version of the Chinese Society of Clinical Oncology(CSCO)guideline was launched in 2017 and has been updated annually based on the latest findings of clinical research,drug accessibility and expert consensus(3-8).Here,we present the main updates of the 2024 version compared to the 2023 version.
2024年版《中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)乳腺癌诊疗指南》融合了2023年国际和国内关键研究进展,充分考虑药物可及性和医保因素,结合中国专家的诊疗建议和共识度,更新了诊疗推荐。指南细化乳腺癌分型和分层治疗,包括激素受体阳性(hormone receptor-positive,HR+)、HER2阳性、三阴性,新增HER2低表达晚期乳腺癌的治疗,为不同分类分层的患者提供规范、精准的治疗方案,指导临床诊疗策略。本文旨在对该指南晚期乳腺癌更新要点进行解读。
The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-based medicine,healthcare resource availability,and precision medicine.These updates address the differences in epidemiological characteristics,clinicopatho-logical features,tumor biology,treatment patterns,and drug selections between Eastern and Western gastric cancer patients.Key revisions include a structured template for imaging diagnosis reports,updated standards for molecular marker testing in pathological diagnosis,and an elevated recommendation for neoadju-vant chemotherapy in stage III gastric cancer.For advanced metastatic gastric cancer,the guidelines introduce new recommendations for immunotherapy,anti-angiogenic therapy and targeted drugs,along with updated management strategies for human epidermal growth factor receptor 2(HER2)-positive and deficient DNA mismatch repair(dMMR)/microsatellite instability-high(MSI-H)patients.Additionally,the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer.The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice,particularly in the heterogeneous healthcare landscape of China,while maintaining a commitment to scientific rigor,impartiality,and timely revisions.
CSCO指南是一种以循证医学为基础的实践指南,已广泛应用于肿瘤的临床治疗,由于指南更新迅速且涵盖了多个学科的知识。多学科综合治疗(MDT)模式是CSCO指南应用实施的有效保障,MDT是肿瘤治疗的最佳实践方法。MDT教学模式基于讨论环节,模拟了真实的诊疗会诊,通过案例分析进行深入探讨,优于传统教学方法。因此,在MDT模式指导下学习CSCO指南有助于提升肿瘤学的实践教学质量。The CSCO guideline is a practice guide based on evidence-based medicine, which has been widely used in the clinical treatment of tumors, due to the rapid update of the guidelines and covering the knowledge of multiple disciplines. The multidisciplinary integrated therapy (MDT) model is an effective guarantee for the application of CSCO guidelines, and MDT is the best practice method for cancer treatment. The MDT teaching mode is based on the discussion link, simulating the real diagnosis and treatment consultation, and conducting in-depth discussion through case analysis, which is better than the traditional teaching methods. Therefore, learning the CSCO guidelines under the guidance of the MDT model helps to improve the quality of practical teaching in oncology.
