School of Medicine, Tongji University, Shanghai, 200092, P. R. China.
Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, P. R. China.
Cancer Commun (Lond). 2022 Oct;42(10):937-970. doi: 10.1002/cac2.12359. Epub 2022 Sep 8.
In China, lung cancer is a primary cancer type with high incidence and mortality. Risk factors for lung cancer include tobacco use, family history, radiation exposure, and the presence of chronic lung diseases. Most early-stage non-small cell lung cancer (NSCLC) patients miss the optimal timing for treatment due to the lack of clinical presentations. Population-based nationwide screening programs are of significant help in increasing the early detection and survival rates of NSCLC in China. The understanding of molecular carcinogenesis and the identification of oncogenic drivers dramatically facilitate the development of targeted therapy for NSCLC, thus prolonging survival in patients with positive drivers. In the exploration of immune escape mechanisms, programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor monotherapy and PD-1/PD-L1 inhibitor plus chemotherapy have become a standard of care for advanced NSCLC in China. In the Chinese Society of Clinical Oncology's guidelines for NSCLC, maintenance immunotherapy is recommended for locally advanced NSCLC after chemoradiotherapy. Adjuvant immunotherapy and neoadjuvant chemoimmunotherapy will be approved for resectable NSCLC. In this review, we summarized recent advances in NSCLC in China in terms of epidemiology, biology, molecular pathology, pathogenesis, screening, diagnosis, targeted therapy, and immunotherapy.
在中国,肺癌是发病率和死亡率较高的原发性癌症类型。肺癌的危险因素包括吸烟、家族史、辐射暴露和慢性肺部疾病。由于缺乏临床表现,大多数早期非小细胞肺癌(NSCLC)患者错过了治疗的最佳时机。基于人群的全国性筛查计划在中国显著有助于提高 NSCLC 的早期发现率和生存率。对分子致癌发生的认识和致癌驱动因素的鉴定极大地促进了 NSCLC 的靶向治疗的发展,从而延长了阳性驱动因素患者的生存时间。在探索免疫逃逸机制的过程中,程序性细胞死亡蛋白 1(PD-1)/程序性死亡配体 1(PD-L1)抑制剂单药治疗和 PD-1/PD-L1 抑制剂联合化疗已成为中国晚期 NSCLC 的标准治疗方法。在中国临床肿瘤学会(CSCO)的 NSCLC 指南中,推荐对放化疗后的局部晚期 NSCLC 进行维持免疫治疗。辅助免疫治疗和新辅助化疗免疫治疗将适用于可切除的 NSCLC。在这篇综述中,我们总结了中国 NSCLC 在流行病学、生物学、分子病理学、发病机制、筛查、诊断、靶向治疗和免疫治疗方面的最新进展。