概述

根据国家癌症中心发布的2022年中国恶性肿瘤流行情况分析报告，肺癌居我国恶性肿瘤发病、死亡首位^[1]。数据显示，2022年肺癌新发病例约106.06万，约占全部恶性肿瘤的22.0%。其中，男性新发病例约65.87万，女性新发40.19万，均为肿瘤发病之首。另外，肺癌也居中国恶性肿瘤死亡首位，2022年因肺癌死亡病例约73.33万，占全部恶性肿瘤死亡的28.5%。其中，男性肺癌死亡病例51.59万，女性21.74万，均为肿瘤死亡首位。肺癌作为中国恶性肿瘤中的主要类型，对公共卫生和患者生活质量造成了严重影响。为了应对这一严峻挑战，中国恶性肿瘤学科发展报告肺癌学科发展报告2024版旨在对2024年度肺癌研究进展进行全面梳理，厘清当前学科研究现状和争论焦点。该报告涵盖了预防、筛查、诊断、治疗、预后评估、新药研发等方面的最新研究，为临床医生和研究者提供指导。

肺癌分为非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC），其中NSCLC占肺癌总数的85%，包括腺癌（LUAD）、鳞癌（LUSC）等亚型。NSCLC因其异质性高、驱动基因突变多样（如EGFR、ALK、ROS1、MET等），精准治疗需求迫切；而SCLC恶性程度高、进展快，治疗手段长期依赖化疗和放疗，近年来免疫治疗逐步突破。本报告在第二章系统梳理了2024年度肺癌研究进展，涵盖预防、筛查、诊断、外科治疗、内科治疗及转化研究等多领域。第三章则聚焦学科发展趋势，包括Ⅲ期NSCLC治疗模式的革新、ADC及双抗药物的临床应用前景、适应性治疗策略的深化等，为未来研究方向提供指引。

总结

2024年，肺癌学科在预防、筛查、诊断、治疗和预后评估等方面取得了显著进展。随着社会的发展，非吸烟者肺癌发病率有上升趋势，特别是在女性中更为显著。环境因素如空气污染和二手烟暴露是主要诱因之一。

肺癌的预防与早期筛查策略持续优化，预防与筛查从风险分层到精准干预全方位保障护航。基于亚洲人群特征的“上海模型”在吸烟相关肺癌风险预测中展现出卓越性能，为低强度吸烟及长期戒烟者提供了更精准的筛查标准，弥补了西方模型在亚洲人群中的局限性。此外，心血管疾病与肺癌的双向关联研究揭示了代谢异常在肺癌发生中的作用，提示未来需加强多学科协作（如心脏肿瘤学），以制定综合防控策略。针对非吸烟人群，TALENT研究验证了LDCT在高危不吸烟者中的筛查价值，尤其是浸润性肺癌的早期检出。然而，原位腺癌的过度诊断问题仍需通过动态风险评估工具（如循环微生物组DNA标志物）进一步优化。生物标志物驱动的筛查模式，结合影像组学与液体活检技术，将成为降低假阳性率、提升筛查效率的关键。

AI与多组学整合进一步发展，在肺癌诊断中的应用实现突破。C-Lung-RADS系统通过整合影像、临床及随访数据，显著提升了肺结节风险分层的准确性，为亚洲人群提供了本土化解决方案。DeepGEM模型通过常规HE病理图像预测基因突变，突破了传统分子检测对组织质量的依赖，为资源匮乏地区提供了高效、低成本的替代方案。液体活检技术（如ctDNA、cfDNA）在动态监测与预后评估中的作用日益凸显。基于ctDNA的适应性治疗策略（如靶向治疗降阶梯）在晚期NSCLC中验证了可行性，减少了药物毒性并延长无治疗间隔。循环微生物组DNA作为新兴生物标志物，在早期诊断及复发预测中展现出高敏感性与特异性，但其临床应用需进一步解决环境因素干扰问题。

外科治疗进一步向精准化迈进。JCOG0802/WJOG4607L研究证实，纯实性NSCLC患者接受肺段切除术的生存获益与年龄、性别相关，提示手术方式需结合患者特征个性化选择。I-SABR在早期肺癌中显著延长EFS，AI赋能的影像组学模型为个体化放疗方案提供了新工具。在局部晚期NSCLC领域，同步放化疗联合靶向或免疫巩固治疗成为新标准，显著延长PFS。SCLC的放疗方案亦获突破，高剂量加速超分割放疗联合化疗在局限期SCLC中实现OS显著延长，而LDRT联合免疫治疗在广泛期SCLC中展现出协同增效潜力。

免疫“夹心饼”模式（新辅助免疫化疗+手术+辅助免疫维持）成为可切除NSCLC的核心策略。Neotorch、RATIONALE-315等研究证实，该模式显著提升pCR与EFS。然而，pCR和MPR作为OS替代终点的有效性仍需验证，未来需探索更可靠的生物标志物（如残余活肿瘤比例）。EGFR突变NSCLC领域，三代TKI巩固了辅助治疗地位，而针对耐药机制（如MET扩增）的双靶联合方案以及双特异性抗体药物方案为后线治疗提供新选择。罕见靶点（如ROS1、RET、METex14）的国产创新药（他雷替尼、伯瑞替尼）在疗效与安全性上媲美国际标准。双抗药物（如依沃西单抗、卡度尼利单抗）通过协同靶向（PD-1/CTLA-4、PD-1/VEGF）实现疗效突破，在晚期NSCLC一线治疗及EGFR-TKI耐药患者中表现优异。ADC药物（如BL-B01D1、Telisotuzumab-Vedotin、Dato-DXd、芦康沙妥珠单抗）凭借精准杀伤与低毒性优势，逐步向一线治疗前移。免疫联合方案（如贝莫苏拜单抗+安罗替尼+化疗）在广泛期SCLC中刷新生存纪录，而靶向DLL3的T细胞衔接器药物（塔拉妥单抗）为后线治疗带来持久缓解。局限期SCLC中，度伐利尤单抗巩固治疗将5年OS率提升至55.9%，奠定了免疫治疗在根治性放化疗后的核心地位。

2024年，肺癌学科在技术创新与临床转化中迈出坚实步伐，从早期筛查到晚期治疗均呈现“精准化、个体化、整合化”趋势。然而，如何将研究成果转化为广泛可及的临床实践，仍是全球学者共同面临的挑战。中国研究者通过本土创新与国际合作，正引领肺癌诊疗进入“长生存、低毒性”的新纪元，为患者点亮希望之光。

【主编】

周彩存   同济大学附属东方医院

【副主编】

陈海泉   复旦大学附属肿瘤医院

李为民   四川大学华西医院

刘宏旭   辽宁省肿瘤医院

王 洁   中国医学科学院肿瘤医院

杨 帆   北京大学人民医院

钟文昭   广东省人民医院

【编委】（按姓氏拼音排序）

陈 椿   福建医大协和医院

陈克能   北京大学肿瘤医院

陈克终   北京大学人民医院

陈 鹏   天津医科大学肿瘤医院

陈智伟   上海市胸科医院

崔久嵬   吉林大学第一医院

董晓荣   华中科技大学同济医学院附属同济医院

范 云   浙江省肿瘤医院

方文峰   中山大学附属肿瘤医院

高树庚   中国医学科学院肿瘤医院

胡 坚   浙江大学医学院附属第一医院

蒋 峰   江苏省肿瘤医院

李鹤成   上海交通大学医学院附属瑞金医院

李 强   四川省肿瘤医院

廖永德   华中科技大学同济医学院附属协和医院

刘安文   南昌大学第二附属医院

刘晓晴   解放军第307医院

柳 影   吉林省肿瘤医院

马少华   北京大学肿瘤医院

马智勇   河南省肿瘤医院

宋启斌   武汉大学人民医院肿瘤中心

宋 勇   南京军区总医院

田子强   河北医科大学第四医院

王 群   复旦大学附属中山医院

吴 楠   北京大学肿瘤医院

熊建萍   南昌大学第一附属医院

徐世东   哈尔滨医科大学附属肿瘤医院

闫小龙   空军军医大学唐都医院

杨浩贤   中山大学肿瘤防治中心

姚 煜   西安交通大学第一附属医院

袁双虎   安徽省肿瘤医院

岳东升   天津医科大学肿瘤医院

张洪涛   苏州大学医学院

张兰军   中山大学肿瘤防治中心

张真发   天津医科大学肿瘤医院

赵明芳   中国医科大学附属第一医院肿瘤内科

周 清   广东省人民医院

朱正飞   复旦大学附属肿瘤医院

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