目的评估中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)人工智能(artificial intelligence,AI)系统在结直肠癌患者临床决策中的适用性和指南符合率,并探讨其在实际临床应用中的可行性。方法纳入2010年1月至2021年12月...目的评估中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)人工智能(artificial intelligence,AI)系统在结直肠癌患者临床决策中的适用性和指南符合率,并探讨其在实际临床应用中的可行性。方法纳入2010年1月至2021年12月在浙江大学医学院附属第二医院确诊并接受治疗的972例结直肠癌患者。通过CSCO AI系统分析患者数据并生成治疗决策,由盲态独立评审委员会(blinded independent central review,BICR)进行决策符合度评分。统计不同治疗阶段的CSCO AI系统适用率和指南符合率,并采用logistic回归模型分析系统在决策中与实际治疗不符的影响因素。结果CSCO AI系统总适用率为96.2%,总指南符合率为94.9%。在辅助治疗和姑息治疗阶段,系统适用率分别为95.8%和96.7%,指南符合率分别为95.0%和94.9%。多因素logistic回归分析显示,年龄≥65岁和高危Ⅱ期治疗阶段是影响CSCO AI系统在辅助治疗阶段指南符合率的重要因素(均P<0.05)。结论CSCO AI系统在结直肠癌辅助治疗和姑息治疗阶段展示了较高的适用率和指南符合率。该系统的临床决策潜力显著,未来可进一步优化其对特定临床情境的判断,推广其在不同医疗机构中的应用。展开更多
Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with inc...Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with incidence and mortality rates continuing to rise(2).The Chinese Society of Clinical Oncology(CSCO)first introduced its guidelines in 2017,and since then,they have been updated annually to incorporate the latest clinical research findings,drug availability,and expert consensus(3-8).This article presents the key updates in the 2025 edition compared to the 2024 version.展开更多
In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided ...In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided additional options for improving patient outcomes.The 2024 Chinese Society of Clinical Oncology Guidelines for NSCLC(CSCO NSCLC),a key reference for clinical oncologists in China,have incorporated current global research and adapted recommendations for applicability in real-world scenarios in China.This update covers not only patient selection,efficacy,and safety,but also considers economics,and accessibility,with an aim to provide more precise and comprehensive treatment guidance for Chinese oncologists.展开更多
The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published s...The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.展开更多
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...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、免疫疗法等新疗法的推荐和采用等方面存在差异,本文基于不同指南内容展现出不同的视角与侧重,以丰富临床决策的维度,增强循证医学指南的临床适应性,进而指导临床实践。展开更多
过去一年,晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)多个临床研究报道更新了研究结果,晚期NSCLC治疗迎来了更多治疗选择、更优疗效及安全性。基于2023年3月—2024年2月的证据,中国临床肿瘤学会(Chinese Society of Clinical ...过去一年,晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)多个临床研究报道更新了研究结果,晚期NSCLC治疗迎来了更多治疗选择、更优疗效及安全性。基于2023年3月—2024年2月的证据,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)更新指南为《中国临床肿瘤学会(CSCO)非小细胞肺癌诊疗指南2024》。该版针对晚期部分的更新包括:EGFR敏感突变、EGFR20号外显子插入、ALK融合、ROS1融合、BRAF V600突变、MET 14外显子跳跃突变、RET融合、HER2突变的治疗部分,以及无驱动基因晚期NSCLC免疫单药治疗及抗体偶联药物(antibody-drug conjugate,ADC)部分。本文将对2024年CSCO NSCLC诊疗指南中有关晚期治疗的这些更新进行详细解读。展开更多
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 prevale...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.展开更多
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...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.展开更多
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...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。展开更多
2021年4月,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)乳腺癌专家委员会发布了2021年的CSCO《乳腺癌诊疗指南》。新版指南在2020年指南的基础上,秉承循证医学证据、兼顾诊治方案可及性的原则,对乳腺癌的诊断检查、...2021年4月,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)乳腺癌专家委员会发布了2021年的CSCO《乳腺癌诊疗指南》。新版指南在2020年指南的基础上,秉承循证医学证据、兼顾诊治方案可及性的原则,对乳腺癌的诊断检查、治疗评估等内容做了推荐调整,同时新增了“靶向药物不良反应管理”、“常态化疫情防控下乳腺癌患者管理”等章节,以期更好地实现患者的全程管理。该文总结新版指南更新要点,并结合最新循证医学进展和药物可及性变化进行了解读。展开更多
对于晚期或转移性胃癌患者,目前公认采取以全身抗肿瘤药物治疗为主的多学科综合治疗和全程多方位管理以延长患者生存时间和改善患者生存质量。中国临床肿瘤学会(CSCO)胃癌诊疗指南每年更新,融合国内外最新的临床研究进展,关注中国人群...对于晚期或转移性胃癌患者,目前公认采取以全身抗肿瘤药物治疗为主的多学科综合治疗和全程多方位管理以延长患者生存时间和改善患者生存质量。中国临床肿瘤学会(CSCO)胃癌诊疗指南每年更新,融合国内外最新的临床研究进展,关注中国人群研究数据和贴近本国临床实践。2021版CSCO转移性胃癌诊疗指南更新主要围绕免疫治疗、抗HER2靶向治疗和胃癌支持治疗等方面展开。基于2020年晚期胃癌在免疫治疗取得重大突破,更新重点聚焦免疫治疗,2021版CSCO指南从新的临床证据出发,针对免疫治疗从一线到三线,如何选择不同的程序性死亡受体-1(programmed cell death 1,PD-1)单抗药物,不同的适用人群均作出了详细推荐及注释,以期规范免疫治疗在晚期胃癌中的应用。本文就2021版CSCO指南对免疫治疗、抗HER2靶向治疗和胃癌支持治疗等方面的更新作总结性的解读,概括性阐明2021版CSCO中反映的晚期转移性胃癌治疗的新进展。展开更多
文摘目的评估中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)人工智能(artificial intelligence,AI)系统在结直肠癌患者临床决策中的适用性和指南符合率,并探讨其在实际临床应用中的可行性。方法纳入2010年1月至2021年12月在浙江大学医学院附属第二医院确诊并接受治疗的972例结直肠癌患者。通过CSCO AI系统分析患者数据并生成治疗决策,由盲态独立评审委员会(blinded independent central review,BICR)进行决策符合度评分。统计不同治疗阶段的CSCO AI系统适用率和指南符合率,并采用logistic回归模型分析系统在决策中与实际治疗不符的影响因素。结果CSCO AI系统总适用率为96.2%,总指南符合率为94.9%。在辅助治疗和姑息治疗阶段,系统适用率分别为95.8%和96.7%,指南符合率分别为95.0%和94.9%。多因素logistic回归分析显示,年龄≥65岁和高危Ⅱ期治疗阶段是影响CSCO AI系统在辅助治疗阶段指南符合率的重要因素(均P<0.05)。结论CSCO AI系统在结直肠癌辅助治疗和姑息治疗阶段展示了较高的适用率和指南符合率。该系统的临床决策潜力显著,未来可进一步优化其对特定临床情境的判断,推广其在不同医疗机构中的应用。
基金supported by the National Natural Science Foundation of China(No.82373415)Beijing Xisike Clinical Oncology Research Foundation(No.Ytongshu2021/ms-0003)。
文摘Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with incidence and mortality rates continuing to rise(2).The Chinese Society of Clinical Oncology(CSCO)first introduced its guidelines in 2017,and since then,they have been updated annually to incorporate the latest clinical research findings,drug availability,and expert consensus(3-8).This article presents the key updates in the 2025 edition compared to the 2024 version.
基金supported by the Shanghai Excellent Academic Leader(Grant No.21XD1423200)。
文摘In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided additional options for improving patient outcomes.The 2024 Chinese Society of Clinical Oncology Guidelines for NSCLC(CSCO NSCLC),a key reference for clinical oncologists in China,have incorporated current global research and adapted recommendations for applicability in real-world scenarios in China.This update covers not only patient selection,efficacy,and safety,but also considers economics,and accessibility,with an aim to provide more precise and comprehensive treatment guidance for Chinese oncologists.
文摘The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.
文摘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、免疫疗法等新疗法的推荐和采用等方面存在差异,本文基于不同指南内容展现出不同的视角与侧重,以丰富临床决策的维度,增强循证医学指南的临床适应性,进而指导临床实践。
基金supported by the Provincial Key R&D Program of Zhejiang Province(No.2021C03125)National Natural Science Foundation of China(No.82373415 and No.82302489)Beijing Xisike Clinical Oncology Research Foundation(No.Y-tongshu2021/ms-0003).
文摘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.
文摘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.
文摘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。
文摘2021年4月,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)乳腺癌专家委员会发布了2021年的CSCO《乳腺癌诊疗指南》。新版指南在2020年指南的基础上,秉承循证医学证据、兼顾诊治方案可及性的原则,对乳腺癌的诊断检查、治疗评估等内容做了推荐调整,同时新增了“靶向药物不良反应管理”、“常态化疫情防控下乳腺癌患者管理”等章节,以期更好地实现患者的全程管理。该文总结新版指南更新要点,并结合最新循证医学进展和药物可及性变化进行了解读。
文摘对于晚期或转移性胃癌患者,目前公认采取以全身抗肿瘤药物治疗为主的多学科综合治疗和全程多方位管理以延长患者生存时间和改善患者生存质量。中国临床肿瘤学会(CSCO)胃癌诊疗指南每年更新,融合国内外最新的临床研究进展,关注中国人群研究数据和贴近本国临床实践。2021版CSCO转移性胃癌诊疗指南更新主要围绕免疫治疗、抗HER2靶向治疗和胃癌支持治疗等方面展开。基于2020年晚期胃癌在免疫治疗取得重大突破,更新重点聚焦免疫治疗,2021版CSCO指南从新的临床证据出发,针对免疫治疗从一线到三线,如何选择不同的程序性死亡受体-1(programmed cell death 1,PD-1)单抗药物,不同的适用人群均作出了详细推荐及注释,以期规范免疫治疗在晚期胃癌中的应用。本文就2021版CSCO指南对免疫治疗、抗HER2靶向治疗和胃癌支持治疗等方面的更新作总结性的解读,概括性阐明2021版CSCO中反映的晚期转移性胃癌治疗的新进展。
