I. Tirohanga Whānui o teESMOAratohu 2025
I te marama o Ākuhata 2025, i tukuna mana e ESMO te Early and locally advanced non small cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up, i whakaputaina i roto i te pukapuka oncology rongonui Annals of Oncology. Koinei te whakahoutanga whānui tuatahi mai i te putanga 2017, ā, he tohutoro tino whai mana mō ngā tohunga oncology o te ao katoa.
Ko te mate pukupuku pūkahukahu te mea tino nui te auau me te mate o ngā mate pukupuku katoa o te ao. I ia tau, neke atu i te 2.2 miriona ngā kēhi hou, me te neke atu i te 1.8 miriona ngā mate, ā, ko te mate pukupuku pūkahukahu te tino take o te mate e pā ana ki te mate pukupuku i roto i ngā tāne me ngā wāhine. Ko te mate pukupuku pūkahukahu ehara i te pūtau iti (NSCLC) te take o te 80-85% o ngā tūroro mate pukupuku pūkahukahu katoa. I runga i tēnei horopaki nui, ko te tukunga o te aratohu 2025 ka werohia he nekehanga pūtaiao hou ki roto i te mahi haumanu, me te whakahoutanga o ngā rautaki whakamātautau tohu koiora he mea tino nui.
II. Te Whakamārama i ngā Whakahōutanga Aratohu Matua
2.1 Te Whakamātautau Tohu Koiora: Mai i te "Whiringa" ki te "Hiranga"
Kei roto i te aratohu o te tau 2025 tētahi whakatikatika rautaki nui e pā ana ki te whakamātautau i ngā tohu koiora. E kī mārama ana te aratohu he mea nui te whakamātautau i ngā tohu koiora hei whakatau maimoatanga mō ngā tūroro me te wāhanga IB-III NSCLC.
Ka whakawhānuihia e tēnei taunakitanga te whakamātautau ngota mai i tana arotahi o mua ki ngā tūroro he mate matatau ki ngā kēhi tīmatanga, ka taea te tango. Ko te whāinga matua ko te tautuhi i ngā whakarerekētanga ira taraiwa me te whakarato i tētahi pūtake pūtaiao mō te maimoatanga tika whaiaro. E whakanui ana hoki te aratohu me whakatau te whaihua o te koiora me te huarahi tātaritanga e tētahi rōpū maha-mātauranga i runga i ngā āhuatanga o te tūroro me te pukupuku.
Mō te rautaki whakamātautau motuhake, e mārama ana te aratohu me whakahaere te whakamātautau ira i mua i te whakatau pokanga, ā, me kapi hoki i te iti rawa te EGFR me te ALK. He hiranga haumanu nui tēnei ariā "whakamātautau wawe" mō te wehewehe tika me te maimoatanga whaiaro o te NSCLC i te wā tōmua – ko te wā tika me te tika o ngā hua whakamātautau ka whakatau tika i te kōwhiringa o te maimoatanga tāpiri i muri mai.
2.2 Ngā Huarahi Whakaora i roto i te NSCLC Wāhanga-Tōmua Pai o te Driver-Oncogene
E whakauru ana te aratohu 2025 i ngā taunakitanga mai i ngā rangahau haumanu nui maha hei whakatū i tētahi ara maimoatanga mārama me te tika mō ngā tūroro he NSCLC wāhanga tōmua he pai ki te driver-oncogene.
Ngā tūroro kua whakarerekētia te EGFR:I runga i te whakamātautau rongonui a ADAURA, kua noho te adjuvant osimertinib i muri i te pokanga mō ngā tau e toru hei paerewa tiaki ā-ao mō ngā tūroro he mukunga EGFR exon 19, he whakarerekētanga exon 21 L858R rānei. Ko te whakamātautau ADAURA he rangahau ā-ao, maha-pokapū, matapōkeretia, whakahaeretia mō te wāhanga III e aromatawai ana i te whai huatanga me te haumaru o te adjuvant osimertinib i roto i ngā tūroro he NSCLC kua tino tangohia te wāhanga IB-IIIA EGFR-mutated. I whakaatuhia e te rangahau he pai ake te oranga kore mate me te oranga whānui o te osimertinib ki te whakataurite ki te placebo, e whakatū ana i te osimertinib hei paerewa tiaki hou mō tēnei taupori. Heoi, i whakaatuhia e ngā tātaritanga tūhura o te whakamātautau ADAURA tata ki te 36% o ngā whakamutu maimoatanga wawe i ahu mai i ngā pānga kino, ā, ko tētahi atu 31% i puta mai i te whakatau a te tūroro. E whakaatu ana tēnei kitenga i te hiahia mō te whakamātautau turanga tika i mua i te maimoatanga kia tino hoatu ai te rongoā kua whakaritea ki ngā tūroro ka taea te whiwhi painga pumau.
Ngā tūroro ALK-pai:I runga i te whakamātautau ALINA, ko te adjuvant alectinib i muri i te pokanga mō ngā tau e rua te paerewa tiaki inaianei. I roto i te tātaritanga tuatahi o te whakamātautau ALINA tuwhera matapōkere wāhanga III, i whakaatu te alectinib i te painga ora kore mate i roto i te taupori wāhanga II-IIIA, me te ōwehenga mōrearea o te 0.24. Ko ngā raraunga whakahou mai i te whakamātautau ALINA i tukuna ki te huihuinga ESMO 2025 i whakaatu i muri i te ≥3 tau o te whai i muri i te whai i muri i te ≥3 tau, ko te painga DFS o te alectinib i noho "mau tonu me te whai tikanga haumanu," me te ōwehenga mōrearea o te 0.36 i roto i te taupori wāhanga II-IIIA. Ko te reiti ora whānui 4-tau hou i tae ki te 98.4%, ko te reiti DFS 4-tau ko te 75.5%, ā, i pai ake hoki te DFS o te pūnaha io matua, me te kore he tohu haumaru hou. Mā ēnei raraunga pakari ka whakapumautia te adjuvant alectinib hei paerewa tiaki i muri i te tango i te NSCLC ALK-pai, ā, e whakaatu ana i te uara o te whakamātautau tika hei tautuhi i aua tūroro.
Te kōwhiringa o te tikanga whakamātautau:E whakamārama ana te aratohu ESMO 2025 i ngāwhakamātautau papa RT-PCR maha-pūkahame te NGS e hangai ana ki te RNA, te IHC, me te FISH hei tētahi o ngā huarahi hangarau e taunakitia ana mō te kimi i te whakakotahitanga ALK. E tohu ana tēnei ko te whakaritenga matua o te aratohu ko te whakahaere i ngā whakamātautau hei ārahi i ngā whakataunga haumanu, kaua ki te whakahau i tētahi tūāpapa whakamātautau motuhake. Mō ngā hua RT-PCR e arotahi ana ki te kimi EGFR me te ALK, ka whakaratohia e tēnei rautaki whakamātautau ngāwari he whakamāramatanga kaha e hangai ana ki ngā aratohu mō tō rātou whakamahinga i roto i te mahi haumanu.
III. Ngā Otinga Hangarau Whakamātautau Tika
Mā te aratohu 2025 ka neke whakamua te whakamātautau ki te wāhanga whakatau i mua i te pokanga, e hiki ake ai te pae mō te tika o te whakamātautau, te aro, me te wātea. Ko ngā hua kitenga e rua e ahu mai ana i te RT-PCR kua whakaahuatia i raro nei e tino rite ana ki ngā whakaritenga o te aratohu mai i te tirohanga hangarau.
3.1 Kete Kimi Huringa EGFR – Pūhara Hangarau ARMS Whakarei ake
Hangarau matuaMā te hangarau ARMS whakarei ake ka taea te whakanui motuhake i ngā raupapatanga mutant iti-rahi ki tētahi papamuri momo-mohoao teitei
Ngā ārai hangarau e toru:
-Ngā ARMS Whakarei ake → whakapai ake i te mohiotanga whakarerekētanga ira
-Whakarei ake i ngā whākōkī → ka keri i ngā papamuri momo-mohoao me te whakarei ake i ngā raupapa ira whakarerekē
-Te aukati pāmahana → te pehi i te whakanui kore-motuhake
MahiTe aro o1% te auau o ngā ira whakarerekētanga
Te whakahaere i te pokeMana whakahaere ā-roto kua hangaia + whākōkī UNG hei ārai i te poke
Te wā hurihanga: Te mahi ngongo kati, tata ki120 meneti
Hototahi tauira:kiko/koiora waitauira → e aro ana ki te whakaritenga "whakamātautau i mua"
Te kapinga:45 ngā whakarerekētanga irai roto i ngā exon EGFR 18-21, e ōrite ana ki ngā rohe kua tohua e te aratohu (ngā mukunga exon 19 me te exon 21 L858R)
Te whakamahinga haumanuHe ārahi tika i te rongoā EGFR-TKI
3.2 Kete Kimi Hononga MMT EML4-ALK – Otinga Kimi Hononga e Hangai ana ki te RNA
-Pūhara hangarauRT-PCR e hangai ana ki te RNA – he painga ā-roto ki ngā tikanga e hangai ana ki te DNA mō te kimi i te hanumi
-Painga e hangai ana ki te RNAKa kitea tika ngā tuhinga whakakotahitanga kua whakapuakina, ā, ka ārai pai i ngā hua kino teka
-Ngā taunakitanga rangahauI roto i ngā whakakotahitanga ALK iti-rahi, he nui ake te pono o te RT-PCR i ngā whakamātautau e hangai ana ki te DNA
-Te aro nui: Ka kitea ngā hanumitanga ki raro ki20 ngā tārua mō ia tauhohenga
-Te kapinga o ngā momo rerekē: Ngā Taupoki12 ngā momo whakakotahitanga EML4-ALK noa(tae atu ki te momo 1 ~33%; ngā momo 3a/3b katoa ~29%)
-Whakahaere me te whakahaere pokeNgongo kati, ~120 meneti; ngā mana whakahaere tukanga kua hangaia + te whākōkī UNG hei ārai i ngā hua teka
-Hototahitanga o ngā taputapuHototahi ki ngā taputapu PCR wā-tūturu rongonui maha
-Te whakarārangi aratohuTino rite ki te aratohu ESMO
IV. Te ōritetanga i waenga i ngā whakamātautau me ngā taunakitanga aratohu
He tino ōrite ngā hua kitenga e rua ki te aratohu ESMO 2025 mō te mate pukupuku pūkahukahu kore-pūtau iti mō ngā wā tōmua me ngā wā ā-rohe kua whanake, i roto i ngā āhuatanga matua e whai ake nei:
V. Whakamutunga
Ko te aratohu NSCLC wāhanga-tōmua a te ESMO 2025 e ārahi ana i tētahi wā hou o te tātaritanga me te maimoatanga tika, e aro ana ki "te whakamātautau i mua i te tīmatanga, te arotahi tika, me te arotau i te maimoatanga."E tutuki ana i te Kete Kite Mutunga EGFR me te Kete Kite Whakakotahitanga MMT EML4-ALK ngā whakaritenga o te aratohu mō ngā whāinga, te wā, me te tika mā roto i ngā ara hangarau motuhake."
Ka whakamahia e te kete EGFR te hangarau ARMS whakarei ake mō te kimi i ngā whakarerekētanga ira kua tohua i roto i ngā tauira iti, e tautoko ana i te koiora kiko me te wai kia taea ai te "whakamātautau i mua."
Ko te kete ALK e hangai ana ki te RT-PCR e hangai ana ki te RNA, e tuku ana i ngā painga ki ngā tikanga DNA mō te kimi hanumi, e hangai ana ki te taunakitanga a ESMO mō ngā panera RT-PCR maha mō te whakamātautau ALK.
Ngātahi, ka hangaia e ēnei hua e rua he otinga whakamātautau tika e tutuki ana i te aratohu ESMO 2025, e tautoko ana i te rongoā tāpiri whaiaro mō te NSCLC wāhanga tōmua.
Ngā Tohutoro:
- Zer A, Ahn MJ, Barlesi F, et al. Matepukupuku pūkahukahu kore-pūtau iti e tere haere ana i te tīmatanga me te rohe: Aratohu Mahi Hauora ESMO mō te tātaritanga, te maimoatanga me te whai i muri mai. Ann Oncol. 2025;36(11):1245-1262. doi:10.1016/j.annonc.2025.08.003
Wā tuku: Mei-06-2026