可切除非小细胞肺癌系统治疗进展与理念变革

Evolution and Paradigm Shift of Systemic Treatment for Resectable Non-Small Cell Lung Cancer

随着肺癌筛查水平的提高及新兴治疗手段的快速进展,非小细胞肺癌(non-small cell lung cancer,NSCLC)可切除人群比例日益扩大,治疗理念也随之发生巨大变革。对于肺癌手术可行性的判定与围手术期管理不再单纯是外科的问题,而是多学科协作的综合管理问题。近年来,靶向治疗和免疫治疗的飞速发展逐渐使可切除NSCLC建立起新的围手术期治疗格局,无论新辅助、辅助或新辅助联合辅助靶向/免疫治疗的结果均令人鼓舞,但药物选择、应用时机和最佳获益人群还需谨慎探讨。全文聚焦围手术期系统治疗的最新进展,并探讨基于这些进展带来的临床治疗理念的变革,以期为临床医生的用药决策提供一定的参考。

With the improvement of lung cancer screening and the availability of new treatment modalities,the proportion of patients diagnosed as resectable non-small cell lung cancer(NSCLC)is increasing,which results in a treatment paradigm shift.The determination of surgical feasibility and perioperative management is no longer just relied on surgical specialty,but becomes a comprehensive issue of multidisciplinary collaboration involving multiple clinical specialties.In recent years,the rapid development of targeted adjuvant therapy and neoadjuvant immunotherapy has gradually established a new framework of the treatment landscape for resectable NSCLC.While the results of these neoadjuvant and adjuvant trials are encouraging,the choice of regimen,the timing of application and the optimal beneficial population need to be carefully selected.This paper will focus on the latest developments in systemic perioperative treatment concepts for resectable NSCLC,and explore the evolution of the clinical treatment paradigm to provide a reference for clinical decision making.