“非小细胞肺癌”的版本间的差异
来自医学百科
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| − | <strong>非小细胞肺癌</strong>（Non-Small Cell Lung Cancer, <strong>NSCLC</strong>）是<strong>[[肺癌]]</strong>最常见的组织学类型，约占肺癌总数的 85%。与<strong>[[小细胞肺癌]]</strong> | + | <strong>非小细胞肺癌</strong>（Non-Small Cell Lung Cancer, <strong>NSCLC</strong>）是<strong>[[肺癌]]</strong>最常见的组织学类型，约占肺癌总数的 85%。与<strong>[[小细胞肺癌]]</strong>相比，NSCLC 生长相对缓慢，早期治愈率较高。它主要包括<strong>[[肺腺癌]]</strong>、<strong>[[肺鳞癌]]</strong>和大细胞癌。 |
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| + | 随着精准医学的突破，治疗模式已发生根本性变革：<strong>[[驱动基因]]</strong>（EGFR/ALK等）阳性患者首选靶向治疗，阴性患者首选免疫治疗。根据最新的 <strong>NCCN Guidelines (v1.2026)</strong>，"围手术期免疫治疗"（Chemo-IO 夹心饼干模式）已全面取代单纯化疗，成为可切除 II-III 期患者的标准治疗。 | ||
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| − | <div style=" | + | 基本信息 · NSCLC |
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| + | <div style="margin-bottom: 10px;"><strong>ICD-10：</strong> <span style="color: #0f172a;">C34</span></div> | ||
| + | <div style="margin-bottom: 10px;"><strong>占比：</strong> <span style="color: #0f172a;">85% (所有肺癌)</span></div> | ||
| + | <div style="margin-bottom: 10px;"><strong>核心亚型：</strong> <strong>[[肺腺癌]]</strong>, <strong>[[肺鳞癌]]</strong></div> | ||
| + | <div style="margin-bottom: 10px;"><strong>关键靶点：</strong> <span style="color: #b91c1c;"><strong>[[EGFR]]</strong>, <strong>[[ALK]]</strong>, <strong>[[KRAS]]</strong></span></div> | ||
| + | <div style="margin-bottom: 10px;"><strong>免疫指标：</strong> <span style="color: #166534;"><strong>[[PD-L1]]</strong>, <strong>[[TMB]]</strong></span></div> | ||
| + | <div style="margin-bottom: 0;"><strong>最新指南：</strong> <span style="color: #64748b;">NCCN v1.2026</span></div> | ||
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| + | <h2 style="border-left: 5px solid #1e40af; padding-left: 15px; color: #0f172a; margin-bottom: 25px;">病理亚型分类</h2> | ||
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| − | < | + | <span style="color: #1e40af; font-weight: bold; font-size: 1.1em;">[[肺腺癌]] (Adenocarcinoma)</span> |
| − | [[ | + | <span style="background-color: #dbeafe; color: #1e40af; padding: 2px 8px; border-radius: 4px; font-size: 0.8em; margin-left: 10px;">最常见 (~50%)</span> |
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| + | <p style="margin: 0 0 10px 0;"><strong>临床特征：</strong>多位于肺周边（周围型）；常见于女性、<strong>不吸烟者</strong>；免疫组化 <strong>[[TTF-1]] (+)</strong>。</p> | ||
| + | <div style="background-color: #f0fdf4; padding: 10px 15px; border-radius: 4px; color: #166534;"> | ||
| + | <strong>🎯 治疗关键：</strong>靶向治疗的金矿。EGFR, ALK, ROS1 高突变，必须进行 <strong>[[NGS]]</strong> 检测。 | ||
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| − | + | <span style="color: #be123c; font-weight: bold; font-size: 1.1em;">[[肺鳞癌]] (Squamous Cell)</span> | |
| − | + | <span style="background-color: #ffe4e6; color: #be123c; padding: 2px 8px; border-radius: 4px; font-size: 0.8em; margin-left: 10px;">~30%</span> | |
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| − | + | <p style="margin: 0 0 10px 0;"><strong>临床特征：</strong>多位于肺中心（中央型），易空洞；与<strong>吸烟</strong>高度相关；免疫组化 <strong>[[p40]] (+)</strong>。</p> | |
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| − | + | <strong>🛡️ 治疗关键：</strong>免疫治疗为主。驱动基因罕见，首选 <strong>[[PD-1]]</strong> + 化疗。 | |
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| − | + | <h2 style="border-left: 5px solid #16a34a; padding-left: 15px; color: #0f172a; margin-bottom: 25px;">分期治疗 (NCCN 2026 Standard)</h2> | |
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| − | + | <h3 style="color: #15803d; margin-bottom: 10px; font-size: 1.1em;">🟢 早期 (I - IIA期) —— 目标：根治</h3> | |
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| − | < | + | <li style="margin-bottom: 8px;"><strong>首选手术：</strong> 肺叶切除 (<strong>[[VATS]]</strong>) + 淋巴结清扫。</li> |
| − | + | <li style="margin-bottom: 8px;"><strong>放疗替代：</strong> 拒手术者选立体定向放疗 (<strong>[[SBRT]]</strong>)。</li> | |
| − | + | <li style="margin-bottom: 8px;"><strong>辅助治疗：</strong> 术后根据基因状态选择 <strong>[[奥希替尼]]</strong> (EGFR+) 或 免疫治疗。</li> | |
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| − | < | + | <h3 style="color: #b45309; margin-bottom: 10px; font-size: 1.1em;">🟡 局部晚期 (IIB - III期) —— 目标：潜在根治</h3> |
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| − | + | <strong>可切除 (IIIA/B) [新标准]：</strong><br> | |
| − | + | 采用 <strong>[[围手术期免疫]]</strong> 模式：新辅助(化疗+免疫) → 手术 → 辅助(免疫)。<br> | |
| − | < | + | <span style="font-size: 0.9em; color: #64748b;">(代表方案：CheckMate-77T / AEGEAN / KEYNOTE-671)</span> |
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| − | + | <strong>不可切除 (IIIB/C)：</strong><br> | |
| − | + | 同步放化疗 (cCRT) → <strong>[[度伐利尤单抗]]</strong> 免疫巩固 (即 PACIFIC 模式)。 | |
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| − | + | <h3 style="color: #475569; margin-bottom: 10px; font-size: 1.1em;">⚪ 晚期 (IV期) —— 目标：延长生存</h3> | |
| − | < | + | <ul style="padding-left: 20px; color: #475569; margin: 0;"> |
| − | + | <li style="margin-bottom: 8px;"><strong>驱动基因 (+)：</strong> 坚决“去化疗”。首选 <strong>[[TKI]]</strong> 靶向药 (如奥希替尼、阿来替尼)。</li> | |
| − | + | <li style="margin-bottom: 8px;"><strong>驱动基因 (-)：</strong> <strong>[[帕博利珠单抗]]</strong> (K药) ± 化疗。</li> | |
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| − | + | <h3 style="font-size: 1em; color: #0f172a; margin-bottom: 15px;">权威参考文献 (Verified)</h3> | |
| − | + | <p style="font-size: 0.9em; color: #64748b; margin-bottom: 8px;"> | |
| − | + | [1] <strong>NCCN Clinical Practice Guidelines in Oncology.</strong> <em>Non-Small Cell Lung Cancer. Version 1.2026.</em> (确立了围手术期免疫治疗标准) | |
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| − | [1] <strong>NCCN Clinical Practice Guidelines in Oncology.</strong> <em>Non-Small Cell Lung Cancer. Version 1.2026.</em> | ||
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</p> | </p> | ||
| − | + | <p style="font-size: 0.9em; color: #64748b; margin-bottom: 8px;"> | |
| − | <p style=" | + | [2] <strong>Wakelee H, et al. (2023).</strong> <em>Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer.</em> <strong>[[New England Journal of Medicine]]</strong>. (KEYNOTE-671研究) |
| − | [2] <strong>Wakelee H | ||
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</p> | </p> | ||
| − | + | <p style="font-size: 0.9em; color: #64748b; margin-bottom: 8px;"> | |
| − | <p style=" | + | [3] <strong>Cascone T, et al. (2024).</strong> <em>CheckMate 77T: Neoadjuvant nivolumab plus chemotherapy...</em> <strong>[[New England Journal of Medicine]]</strong>. (围手术期O药数据) |
| − | [3] <strong>Cascone T | ||
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</p> | </p> | ||
| − | + | <p style="font-size: 0.9em; color: #64748b; margin-bottom: 8px;"> | |
| − | <p style=" | + | [4] <strong>Wu YL, et al. (2020).</strong> <em>Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer.</em> <strong>[[New England Journal of Medicine]]</strong>. (ADAURA研究) |
| − | [4] <strong>Wu YL | ||
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</p> | </p> | ||
| − | + | <p style="font-size: 0.9em; color: #64748b; margin-bottom: 0;"> | |
| − | <p style=" | + | [5] <strong>Antonia SJ, et al. (2017).</strong> <em>Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer.</em> <strong>[[New England Journal of Medicine]]</strong>. (PACIFIC模式) |
| − | [5] <strong>Antonia SJ | ||
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| − | + | <strong>相关词条：</strong> | |
| − | + | [[EGFR]] • [[ALK]] • [[奥希替尼]] • [[帕博利珠单抗]] • [[新辅助治疗]] • [[液体活检]] | |
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2026年1月27日 (二) 10:25的版本
非小细胞肺癌（Non-Small Cell Lung Cancer, NSCLC）是肺癌最常见的组织学类型，约占肺癌总数的 85%。与小细胞肺癌相比，NSCLC 生长相对缓慢，早期治愈率较高。它主要包括肺腺癌、肺鳞癌和大细胞癌。
随着精准医学的突破，治疗模式已发生根本性变革：驱动基因（EGFR/ALK等）阳性患者首选靶向治疗，阴性患者首选免疫治疗。根据最新的 NCCN Guidelines (v1.2026)，"围手术期免疫治疗"（Chemo-IO 夹心饼干模式）已全面取代单纯化疗，成为可切除 II-III 期患者的标准治疗。
病理亚型分类
分期治疗 (NCCN 2026 Standard)
🟢 早期 (I - IIA期) —— 目标：根治
🟡 局部晚期 (IIB - III期) —— 目标：潜在根治
权威参考文献 (Verified)
[1] NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer. Version 1.2026. (确立了围手术期免疫治疗标准)
[2] Wakelee H, et al. (2023). Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer. New England Journal of Medicine. (KEYNOTE-671研究)
[3] Cascone T, et al. (2024). CheckMate 77T: Neoadjuvant nivolumab plus chemotherapy... New England Journal of Medicine. (围手术期O药数据)
[4] Wu YL, et al. (2020). Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer. New England Journal of Medicine. (ADAURA研究)
[5] Antonia SJ, et al. (2017). Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. New England Journal of Medicine. (PACIFIC模式)