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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,要点,肺癌筛查,各种分期的治疗选择,放疗,小分子靶向始疔,化疗,免疫治疔,病理学评佑(免疫组化),要点,1,肺癌筛査的重要性,85%-90%的肺癌是由于主动吸烟或被动吸烟所致,和吸烟者生活在一起(吸二手烟)人群罹患肺癌的风险上升20%-30%,肺癌筛査的重要性,2,针对高危人群,每年LDCT可降低20%肺癌,Methods-From August 2002 through April 2004. we enrolled 53. 454 persons at high risk,lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three,annual screenings with either low-dose CT(26.722 participants)or single-view posteroanterior,chest radiography(26. 732). Data were collected on cases of lung cancer and deaths from lung,ancer that occured through december 31. 2009,Results-The rate of adherence to screening was more than 90%o. The rate of positive screening,tests was 24.2%a with low-dose CI and 6.9%o with radiography over all three rounds. A total of,96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography,group were false positive results. The incidence of lung cancer was 645 cases per 100, 000 person,years(1060 cancers) in the low-dose CT group as compared with 572 cases per 100,000 person,years(941 cancers)in the radiography group (rate ratio.,95% confidence interval Cl. 1.03,23). There were 247 deaths from lung cancer per 100.000 person-years in the low-dose CT,group and 309 deaths per 100, 000 person-years in the radiography group representing a relative,reduction in mortality from hung cancer with low-dose CT screening of 20000(95%CI.6.8 to,6.7: P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as,ompared with the radiography group. by 6. 7%(95%Cl, 1.2 to 13.6: P=0.02),Conclusions-Screening with the use of low-dose CT reduces mortality from lung cancer,Aberle DR, Adams AM, et a. N Engl J Med 2011: 365. 395-409,针对高危人群,每年LDCT可降低20%肺癌,3,高危组人群:年龄55-74岁,吸烟史30包年,戒烟15年(1类),年龄50岁,吸烟史20包年,具有被动吸烟以外的危险因素(2A类),危险因素:吸烟史、氡暴露史、职业史、患癌史、肺癌家族史、慢性肺病或肺结核,烟雾接触史(被动吸烟),RISK STATUS,Age 55-74 y an,230 pack-year history of smoking,Smoking cessation 15,candidates for screening,exposured,Age50yand,commended, including a,discussion of benefits risks,220 pack-year history of smoking a,first-degree relati,second-hand smoke,isease history (CoPD ol,Smoking exposure(second,220 pack-year history of smoking,Lung cancer screening not,No additional riek factore,symptoms, see appropriate,Lowrisk:,NCCN Guidelines,Lung cancer screening not,20 pack-year history of smoking,高危组人群:年龄55-74岁,吸烟史30包年,戒烟3cm或有淋巴结转移等)推荐,脑MR】,辅助化疗分界线,高危因素包括:T4cm、NX、低分化或神经内分泌肿瘤、楔形切除、脏层胸,膜受累,其余期:化疗(类):如切缘阳性,再次手术+化疗放化疗,期、淋巴结阴性的期(T1-3N0),尤其是期(T1-2aNo)患者,如无法手术,推荐立体定向消融放疗(SABR),2分期治疗,9,2分期治疗,A期(T13N2,T3N1):化疗(类)+辅助放疗(N2时):如切缘阳性,放,化疗,根治手术,分界线,IA期(T4N0-1):可能可切除,术前同步放化疗一-再次评估手术的可能性,如能,手术则行手术+化疗,否则行根治性放疗+化疗。不可切除,行根治性同步放化,B期:根治性同步放化疗。(临床诊断期时,纵膈镜、胸腔镜,穿刺活检、锁骨上淋巴结活检进一步确认分期价值较大),可行手术患者,术前均推荐行PETc,2分期治疗,10,非小细胞肺癌医学知识指南解读课件,11,非小细胞肺癌医学知识指南解读课件,12,非小细胞肺癌医学知识指南解读课件,13,非小细胞肺癌医学知识指南解读课件,14,非小细胞肺癌医学知识指南解读课件,15,非小细胞肺癌医学知识指南解读课件,16,非小细胞肺癌医学知识指南解读课件,17,非小细胞肺癌医学知识指南解读课件,18,非小细胞肺癌医学知识指南解读课件,19,非小细胞肺癌医学知识指南解读课件,20,非小细胞肺癌医学知识指南解读课件,21,非小细胞肺癌医学知识指南解读课件,22,非小细胞肺癌医学知识指南解读课件,23,非小细胞肺癌医学知识指南解读课件,24,非小细胞肺癌医学知识指南解读课件,25,非小细胞肺癌医学知识指南解读课件,26,非小细胞肺癌医学知识指南解读课件,27,非小细胞肺癌医学知识指南解读课件,28,非小细胞肺癌医学知识指南解读课件,29,非小细胞肺癌医学知识指南解读课件,30,非小细胞肺癌医学知识指南解读课件,31,非小细胞肺癌医学知识指南解读课件,32,非小细胞肺癌医学知识指南解读课件,33,非小细胞肺癌医学知识指南解读课件,34,非小细胞肺癌医学知识指南解读课件,35,非小细胞肺癌医学知识指南解读课件,36,非小细胞肺癌医学知识指南解读课件,37,非小细胞肺癌医学知识指南解读课件,38,非小细胞肺癌医学知识指南解读课件,39,非小细胞肺癌医学知识指南解读课件,40,非小细胞肺癌医学知识指南解读课件,41,非小细胞肺癌医学知识指南解读课件,42,非小细胞肺癌医学知识指南解读课件,43,非小细胞肺癌医学知识指南解读课件,44,非小细胞肺癌医学知识指南解读课件,45,非小细胞肺癌医学知识指南解读课件,46,非小细胞肺癌医学知识指南解读课件,47,非小细胞肺癌医学知识指南解读课件,48,非小细胞肺癌医学知识指南解读课件,49,非小细胞肺癌医学知识指南解读课件,50,非小细胞肺癌医学知识指南解读课件,51,非小细胞肺癌医学知识指南解读课件,52,非小细胞肺癌医学知识指南解读课件,53,非小细胞肺癌医学知识指南解读课件,54,非小细胞肺癌医学知识指南解读课件,55,非小细胞肺癌医学知识指南解读课件,56,非小细胞肺癌医学知识指南解读课件,57,非小细胞肺癌医学知识指南解读课件,58,非小细胞肺癌医学知识指南解读课件,59,非小细胞肺癌医学知识指南解读课件,60,非小细胞肺癌医学知识指南解读课件,61,非小细胞肺癌医学知识指南解读课件,62,非小细胞肺癌医学知识指南解读课件,63,非小细胞肺癌医学知识指南解读课件,64,非小细胞肺癌医学知识指南解读课件,65,非小细胞肺癌医学知识指南解读课件,66,非小细胞肺癌医学知识指南解读课件,67,非小细胞肺癌医学知识指南解读课件,68,非小细胞肺癌医学知识指南解读课件,69,非小细胞肺癌医学知识指南解读课件,70,非小细胞肺癌医学知识指南解读课件,71,非小细胞肺癌医学知识指南解读课件,72,非小细胞肺癌医学知识指南解读课件,73,非小细胞肺癌医学知识指南解读课件,74,非小细胞肺癌医学知识指南解读课件,75,非小细胞肺癌医学知识指南解读课件,76,非小细胞肺癌医学知识指南解读课件,77,非小细胞肺癌医学知识指南解读课件,78,
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