Lung cancer is the malignancy with the highest incidence and mortality rate in China. In recent years, the popular use of low-dose computed tomography in the population has led to an increase in the detection rate of pulmonary nodules. The National Comprehensive Cancer Network (NCCN) updated and released the NCCN clinical practice guidelines in oncology for non-small cell lung cancer (version 2.2023) on February 17, 2023. This article will interpret the main updates of the new guideline and compare it with the domestic lung cancer treatment guidelines, providing new ideas for the diagnosis and treatment of lung cancer for Chinese clinicians.
Chinese Medical Association Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2023 Edition) has been released in July 2023. Based on the 2022 edition, the 2023 edition of the guideline has been updated in the aspects of lung cancer screening, pathology, surgical standards, neoadjuvant therapy, targeted therapy and treatment of advanced lung cancer. This article will give a brief introduction to these updated parts.
“Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer （version-2022）” （China Liver Cancer Staging, Abbreviation “CNLC 2022”） was updated recently and the “Barcelona Clinical Liver Cancer Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 update” （Abbreviation “BCLC 2022”） was also updated in December 2021. The similarities and differences of the two guidelines were interpreted. For the BCLC stage B and C, which are equivalent to CNLC stage Ⅱa and Ⅱb and CNLC stage Ⅲa, respectively, the recommendation of surgical treatment and radiation therapy are disparate in the CNLC 2022 and BCLC 2022. For the systematic treatment of advanced liver cancer, Atezolizumab-Bevacizumab, Renvatinib and Sorafenib were both recommended as the first-line medication in the two guidelines. However, the CNLC 2022 is more flexible than BCLC 2022, which provides more treatment options for Chinese liver cancer patients. It is worth paying attention to two important new concepts proposed in the BCLC 2022: stage migration during treatment and untreatable progression. The BCLC stage B was divided into three subgroups according to tumor burden and liver function and different clinical pathways were recommended in the BCLC 2022.
National Comprehensive Cancer Network (NCCN) has updated and released the latest content of NCCN guidelines version 1. 2023 thymomas and thymic carcinomas (known as "guidelines"). The guideline sets standards for the diagnosis and treatment of thymoma and thymic carcinoma based on high quality clinical evidence and the latest advances in research. There have been some updates and revisions in the latest two versions of the guidelines, mainly focusing on the principles of radiotherapy, the principles of systematic therapy, multidisciplinary participation and the improvement of some footnotes, compared with the first version of the guidelines in 2022. In this paper, the contents of the new guideline will be interpreted in order to provide reference for the work of thymoma and thymic carcinoma in our country at the present stage.
Venous thromboembolism (VTE), comprising both deep vein thrombosis and pulmonary embolism, is a chronic illness that contributes significantly to the global burden of disease. The American College of Chest Physicians (ACCP) published the 9th edition of antithrombotic treatment guidelines for VTE (AT9) in 2012, which was first updated in 2016. In October 2021, ACCP published the 2nd update to AT9, which addressed 17 clinical questions related to VTE and presented 29 guidance statements in total. In this paper we interpreted the recommendations proposed in this update of the guidelines.
The Universal Definition and Classification of Heart Failure consensus has proposed the universal definition, classification and staging criteria of heart failure. The prevalence of heart failure is still increasing, and the phenotype of heart failure with preserved ejection fraction (HFpEF) is becoming more and more common. Neuro-endocrine antagonists are effective in treating patients with heart failure with reduced ejection fraction (HFrEF). However, there is no effective drug that can improve the clinical prognosis of patients with HFpEF. The pathophysiological mechanism of HFpEF involves metabolic-inflammatory mechanism disorders, epicardial fat tissue accumulation, and coronary microvascular dysfunction. The exploratory treatment of these mechanisms requires further research to confirm whether it is beneficial to patients with HFpEF. In addition, the improvement of ejection fraction and the recovery of cardiac function in patients with HFrEF after treatment cannot interrupt the drug treatment of heart failure.
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
Lung cancer is the malignant tumor with the highest incidence rate in men and the highest mortality rate in men and women in China, and the incidence and mortality rates are still increasing. Lung cancer screening is an important initiative for early detection of lung cancer and improvement of prognosis. The National Comprehensive Cancer Network (NCCN) updates the NCCN Clinical Practice Guidelines for Lung Cancer Screening annually, and the 2023 V2 edition was released in May 2023. The guidelines are based on the latest research advances and high-level evidence-based medical evidence to establish screening criteria for lung cancer, especially for non-small cell lung cancer, which is the most common and highly regarded type of lung cancer, and has received widespread attention from physicians worldwide. In this article, the latest version of the guideline will be interpreted based on China's national situation and Chinese lung cancer screening guidelines, with the aim of providing an updated reference for lung cancer screening in China.
In recent years, the worldwide incidence rate of peripheral arterial and aortic diseases has increased year by year, significantly increasing the cardiovascular mortality and incidence rate of the whole population. In the past, peripheral arterial and aortic diseases were often more prone to missed diagnosis and delayed treatment compared to coronary artery disease. The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases for the first time combines peripheral arterial and aortic diseases, integrating and updating the 2017 guidelines for peripheral arterial disease and the 2014 guidelines for aortic disease. The aim is to provide standardized recommendations for the management of systemic arterial diseases, ensuring that patients can receive coherent and comprehensive diagnosis and treatment, thereby improving prognosis. This article interprets the main content of the guideline in order to provide reference and assistance for the clinical diagnosis and treatment of peripheral arterial and aortic diseases in China at the current stage.
“Definition and diagnostic criteria for clinical obesity” (referred to as the “Guideline”), jointly developed by The Lancet Diabetes & Endocrinology Commission, was officially released on January 25, 2025. The Guideline presents a groundbreaking perspective by explicitly defining clinical obesity as a chronic disease and establishing a stratified diagnostic system. It mandates the combined use of anthropometric measurements and clinical assessments, promoting a shift in the diagnosis and treatment model from “body weight management” to comprehensive intervention focused on “body fat metabolism and organ function protection”. Through a systematic interpretation of the core content of the Guideline, including the definition of clinical obesity, key diagnostic criteria, criteria for differential diagnosis, and clinical significance, the document emphasizes the profound impact of the Guideline on the adjustment of medical insurance policies, the standardization of clinical practices, and the protection of patient rights, and aims to enhance the precision diagnosis and stratified management of obesity.