Shandong Provincial Medical Association multidisciplinary standardized diagnosis and treatment guidelines for esophageal carcinoma （2023 Edition）

doi:10.3760/cma.j.cn371439-20230612-00077

Abstract

Abstract:

Esophageal carcinoma is at a high incidence in Shandong province，and there are many non-standard aspects in the current diagnosis and treatment. The standardized diagnosis and treatment of multiple disciplines，including medical oncology，surgical oncology，radiotherapy，imaging，endoscopy，pathology，etc.，is crucial to improve local control，overall survival rate，and quality of life. This guideline is hereby formulated based on clinical needs and combined with the progress of multidisciplinary diagnosis and treatment in recent years.

Key words: Esophageal neoplasms, Multidisciplinary diagnosis and treatment

Shandong Medical Association Multidisciplinary Joint Committee on Lung Cancer. Shandong Provincial Medical Association multidisciplinary standardized diagnosis and treatment guidelines for esophageal carcinoma （2023 Edition）[J]. Journal of International Oncology, 2023, 50(7): 385-397.

Figures/Tables 8

References 56

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推荐级别	说明
Ⅰ级	可及性好、获益性高的1A类证据、部分2A类证据
Ⅱ级	可及性差、效价比低的1B类证据、部分2A类证据
Ⅲ级	探索性的、但有一致共识的2B类证据、3类证据

方案	推荐级别	证据级别	备注
卡瑞利珠单抗+紫杉醇+顺铂	Ⅰ级	1A类	鳞状细胞癌
帕博利珠单抗+氟尿嘧啶/卡培他滨+顺铂	Ⅰ级	1A类	CPS≥10
纳武利尤单抗+氟尿嘧啶+顺铂	Ⅰ级	1A类	鳞状细胞癌
纳武利尤单抗+氟尿嘧啶/卡培他滨+奥沙利铂	Ⅰ级	1A类	HER-2阴性腺癌，CPS≥5
信迪利单抗+顺铂+氟尿嘧啶/紫杉醇	Ⅰ级	1A类	鳞状细胞癌
信迪利单抗+奥沙利铂+卡培他滨	Ⅰ级	1A类	HER-2阴性腺癌，CPS≥1
特瑞普利单抗+紫杉醇+顺铂	Ⅰ级	1A类	鳞状细胞癌
替雷利珠单抗+顺铂+紫杉醇/氟尿嘧啶/卡培他滨	Ⅰ级	1A类	鳞状细胞癌
替雷利珠单抗+顺铂+氟尿嘧啶	Ⅰ级	1A类	PD-L1阳性、HER-2阴性腺癌
替雷利珠单抗+奥沙利铂+卡培他滨	Ⅰ级	1A类	HER-2阴性腺癌
斯鲁利单抗+顺铂+氟尿嘧啶	Ⅰ级	1A类	鳞状细胞癌，CPS≥1
纳武利尤单抗+奥沙利铂+氟尿嘧啶/卡培他滨	Ⅱ级	1A类	CPS<5，或未检测PD-L1
纳武利尤单抗+伊匹木单抗	Ⅱ级	1A类	不宜或拒绝化疗的鳞状细胞癌，CPS≥1
卡瑞利珠单抗+紫杉醇脂质体+奈达铂+阿帕替尼	Ⅲ级	3类	鳞状细胞癌

方案	推荐级别	证据级别	备注
卡瑞利珠单抗	Ⅰ级	1A类	鳞状细胞癌
帕博利珠单抗	Ⅰ级	1A类	鳞状细胞癌，CPS≥10
纳武利尤单抗	Ⅰ级	1A类	鳞状细胞癌（二线或以上）；腺癌（三线或以上）
替雷利珠单抗	Ⅰ级	1A类	鳞状细胞癌
卡瑞利珠单抗+阿帕替尼	Ⅲ级	3类	鳞状细胞癌

FN发生率	治疗模式	推荐措施
>20%	高危方案（如DCF方案）±同步放疗	预防性使用长效或短效G-CSF
10%~20%	中危方案（如紫杉醇+顺铂、伊立替康+顺铂、表柔比星+顺铂+氟尿嘧啶、表柔比星+顺铂+卡培他滨；新辅助放化疗者接受长春瑞滨+顺铂方案；不能手术者接受顺铂+紫杉醇联合放疗剂量>60 Gy）	有高危因素者推荐预防性使用长效或短效G-CSF
<10%	低危方案	不常规推荐，但有高危因素者可考虑使用长效或短效G-CSF

分层	Ⅰ级推荐	Ⅱ级推荐	Ⅲ级推荐
CTIT有出血	输注血小板，或输注血小板+IL-11/rhTPO（1A类证据）	TPO-RA（2B类证据）
CTIT无出血
血小板≤10×10⁹/L	输注血小板，或输注血小板+IL-11/rhTPO（1A类证据）	TPO-RA（2B类证据）
10×10⁹/L<血小板<75×10⁹/L	IL-11或rhTPO（1A类证据）	TPO-RA（2B类证据）	咖啡酸片（3类证据）
75×10⁹/L≤血小板<100×10⁹/L	密切观察血小板变化及出血情况（1A类证据）