中国县域肺癌临床诊疗路径(2023版)

Clinical pathway in Chinese county for lung cancer diagnosis and treatment (2023 edition)

在全球范围内,肺癌是导致恶性肿瘤患者死亡的首要原因。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。然而,目前县域医院普遍面临先进诊疗技术不可及的问题。因此,在制定质控标准和临床诊疗规范时,必须结合县域医院的实际情况,拟定具体的推荐措施。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,中国胸部肿瘤研究协作组组织专家编撰了《中国县域肺癌临床诊疗路径(2023版)》。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,以及基于病理类型、分期和分子分型的精准治疗,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。同时,路径根据县域医院的实际工作情况,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。路径中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都严格参照了现有的指南和共识,确保了科学性。

Lung cancer(LC)is the leading cause of death among patients with cancer both in worldwide and China.China accounts for 11.4%of the total number of cancer cases and 18.0%of the total number of cancer deaths in the world.Standardizing the diagnosis and treatment of LC is a key measure to improve the survival rate of LC 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.In order to solve the above problems,based on existing guidelines at home and abroad and the clinical work characteristics of county hospitals,the first clinical pathway in Chinese county for LC diagnosis and treatment(2023 edition)was compiled.This pathway elaborated on the imaging diagnosis,pathological diagnosis,molecular testing,and precision medicine based on histological-pathological types,tumor-node-metastasis(TNM)classification,and molecular classification,developed different diagnosis and treatment processes for different types of LC patients.Simultaneously,according to the actual work situation of county hospitals,the diagnosis and treatment recommendations in clinical scenarios are divided 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,ensuring the scientificity.