The "Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2025 edition)" was collaboratively completed under the leadership of Professor Han Baohui from the Department of Pulmonary and Critical Care Medicine at Shanghai Chest Hospital and Professor Wang Jie from the Department of Medical Oncology at the Cancer Hospital of the Chinese Academy of Medical Sciences & Peking Union Medical College. The guideline involved the cooperation of more than 50 lung cancer diagnosis and treatment institutions and over 100 experts across China. Since the completion of the first edition in 2018, the guideline is typically revised annually to promptly incorporate the latest advancements in the field of lung cancer. The most distinctive feature of these guidelines is that they exclusively reference the indications approved by the National Medical Products Administration of China. At the same time, particular emphasis is placed on integrating clinical research data from Chinese scholars based on Chinese patients, thereby enhancing the guidelines' authority, applicability, and drug accessibility. The "Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2025 edition)" was officially published in September 2025. To better introduce the key points of the guidelines to peers, this interpretation has been prepared.
Objective: To analyze the clinicopathological factors affecting the prognosis of patients after curative resection of lung metastases (LMs) from colorectal cancer (CRC) and to construct a clinical risk scoring (CRS) model. Methods: This study retrospectively collected clinicopathological data and follow-up information on 132 patients who underwent radical resection of LMs from CRC at the Cancer Hospital of the Chinese Academy of Medical Sciences between January 2010 and December 2020. We analyzed the clinicopathological factors influencing patient prognosis using univariate and multivariate Cox proportional hazards regression models, and we developed a risk stratification model for prognostic prediction. Results: The median follow-up duration for the cohort of 132 patients was 54.2 months. During this period, 61 patients (46.2%) experienced recurrence or distant metastasis, resulting in a 5-year DFS rate of 54.1%. Additionally, 33 patients (25.0%) died, corresponding to a 5-year overall survival (OS) rate of 76.7%. Univariate Cox proportional hazards regression model analysis indicated that ten clinicopathological factors were significantly associated with OS (all P＜0.05). These factors include the total number of lymph nodes (LNs) dissected from the primary tumor (PT) <16, the number of negative LNs from the PT <13, pN(+) of the PT, logarithmic odds of positive lymph nodes (LODDS) of the PT ≥-1.1, lymph nodes ratio (LNR) of the PT ≥0.02, preoperative carcinoembryonic antigen (CEA) level before LMs resection ≥10 ng/ml, the presence of hilar/mediastinal LN metastasis, the number of LMs ≥2, the maximum diameter of LMs ≥2.5 cm, and the necessity for hilar/mediastinal lymphadenectomy. Multivariate Cox proportional hazards regression analysis identified the number of negative LNs <13 (HR=3.01, 95% CI: 1.28-7.03, P=0.011), pN(+) of the PT (HR=5.04, 95% CI: 1.51-16.84, P=0.009), preoperative CEA level before LMs resection ≥10 ng/ml (HR=5.39, 95% CI: 1.80-16.19, P=0.003), the number of LMs ≥2 (HR=2.47, 95% CI: 1.09-5.60, P=0.030), and the necessity for hilar/mediastinal lymphadenectomy (HR=2.74, 95% CI: 1.15-6.52, P=0.023) as independent prognostic risk factors. Patients were categorized based on independent risk factors, revealing statistically significant differences in OS across the groups with CRS scores of ≤2, 3～4, and ≥5 (P＜0.001). Conclusions: Independent risk factors associated with LMs from CRC patients include the number of negative LNs <13, pN(+) of the PT, preoperative CEA level before LMs resection ≥10 ng/ml, the number of LMs ≥2, and the necessity for hilar/mediastinal lymphadenectomy. Patients scoring 3 or higher on the CRS model may warrant cautious assessment for the appropriateness of direct surgical treatment.
Objective: This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival. Methods: Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed. Results: Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications (P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age (HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels (HR=1.24,95% CI:1.02-1.51), perineural invasion (HR=1.44,95% CI:1.14-1.81), vascular invasion (HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2:HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis (HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage (HR=1.26,95% CI:1.04-1.53), intraoperative blood loss (HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas (HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage (HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions: Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.
Non-inferiority clinical trials are a research paradigm that employs randomized controlled methods to evaluate whether the treatment effect of the experimental group is not inferior to that of the active control group within a predefined acceptable margin. This article systematically summarizes the applicable conditions, key design elements, and statistical analysis methods for non-inferiority trials. By integrating representative case studies in the field of oncology, it elucidates the unique value of non-inferiority designs in balancing benefits and risks and in optimizing therapeutic decisions. Through reviewing theoretical frameworks and addressing common misconceptions in methodological practices, this study aims to provide clear guidance for the standardized design and scientific interpretation of non-inferiority trials, thereby promoting their high-quality application in clinical research.
Breast cancer is one of the most prevalent malignancies among women globally and ranks second in the incidence of malignant tumors among Chinese women. It has become a significant public health issue that seriously threatens women's health, highlighting the urgent need to establish a precision prevention and treatment system. Currently, the diagnosis and treatment of breast cancer have transitioned from traditional histological classification to a precision medicine phase centered on molecular characteristics, significantly enhancing the specificity and effectiveness of clinical treatments. With the rapid development of molecular biology techniques, the continuous discovery and application of new biomarkers have fueled the growing demand for molecular pathological testing in clinical settings. The widespread use of various molecular testing platforms has driven clinical decision-making from population-based and standardized approaches to individualized and refined strategies. This shift enables clinicians to more accurately assess patient prognosis and predict treatment responses, thereby formulating more appropriate treatment plans. However, the emergence of new technologies and biomarkers has also increased the requirements for standardization, normalization of testing procedures, and the establishment of quality control. While this trend brings new opportunities for precision diagnosis and treatment of breast cancer, it also poses higher demands on clinical and pathological practices, necessitating the establishment of unified precision diagnosis and treatment pathways and consensus. The "Guidelines on clinical practice of molecular tests in breast cancer in China (2025 edition)" was developed through a multidisciplinary collaboration among experts in molecular pathology and breast oncology, integrating domestic clinical realities with international advancements. We systematically evaluated evidence quality (GRADE criteria) and recommendation strength based on global clinical studies and practical experiences. The guideline aims to harmonize localized molecular diagnostic expertise with global insights, addressing critical needs in precision therapeutics, hereditary susceptibility assessment, and prognostic recurrence risk stratification. It proposes optimized clinical testing algorithms, emphasizes multidisciplinary integration, and establishes standardized protocols to ensure robust implementation of molecular diagnostics in China. This document serves as an authoritative reference for clinicians and pathologists to refine individualized patient management and jointly promotes the realization of the "Healthy China 2030" strategic goal.
Cervical cancer is one of the most common malignant tumors among women worldwide and represents a significant public health issue threatening women's health. In recent years, the disease burden of cervical cancer in China has been increasing, with women aged 45 and older bearing a particularly heavy burden. This population not only has the highest incidence and mortality rates but also represents the second peak age group for high-risk human papilloma virus (HR-HPV) infection, with the HR-HPV infection rate remaining consistently high. The causes of this situation are multifaceted. On one hand, the target group for HPV vaccination in China is women aged 9-45, which has resulted in very limited vaccination rates among middle-aged and older women when they were within the recommended age range. Additionally, this demographic has relatively low awareness of the HPV vaccine. On the other hand, aging-related declines in immune function and hormonal changes increase the risk of persistent HR-HPV infection in this group. The latent nature of HPV infection further complicates the early detection of the disease. At the same time, cervical cancer screening coverage among middle-aged and older women in China remains low and shows significant regional disparities, with screening rates in economically disadvantaged areas being markedly lower than those in more affluent regions. Furthermore, physiological changes associated with aging reduce the accuracy of conventional screening methods in this population, leading to insufficient early detection and intervention for cervical cancer. As a result, many patients are diagnosed at an advanced stage of the disease, significantly increasing treatment difficulty and disease burden. This article reviewed the burden of cervical cancer and HR-HPV infection among middle-aged and older women in China, the associated influencing factors, and the status of comprehensive prevention and control measures, aiming to provide a reference for improving cervical cancer prevention strategies for middle-aged and older women in China and contribute to the country's efforts to eliminate cervical cancer.
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