Management of Patients With Early-Stage Non-Small Cell Lung Cancer: An American College of Chest Physicians Clinical Practice Guideline.

This CHEST organization guideline examines the literature on primary treatment of patients with stage I and II non-small cell lung cancer (NSCLC) to provide evidence-based recommendations.

本CHEST组织指南审查了关于I期和II期非小细胞肺癌（NSCLC）患者主要治疗的文献，以提供基于证据的建议。

study_design_and_methods

An expert panel conducted a systematic reviewaddressing the treatment options for patients with stage I/II NSCLC and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of evidence and grading of recommendations.

一个专家小组进行了一项系统评价，旨在解决I/II期非小细胞肺癌患者的治疗选择问题，并应用了证据质量评估、推荐等级的制定、发展和评价方法来评估证据的确定性和推荐等级。

A modified Delphi approach was used to reach consensus on recommendations.

使用了改良的德尔菲方法来达成关于推荐的共识。

Results

Based on 578 studies, the panel developed 17 recommendations.

基于578项研究，专家组制定了17条推荐意见。

interpretation

The best treatment for average or low operative risk patients with stage I NSCLC remains surgical resection.

对于平均或低手术风险的I期非小细胞肺癌患者，最佳治疗方式仍然是外科切除术。

In patients with stage I NSCLC, a minimally invasive approach is preferred over thoracotomy.

在 I 期非小细胞肺癌患者中，与开胸手术相比，更倾向于采用微创方法。

For the first time, a meta-analysiscomparing overall survivalfor patients with stage I lung cancer reveals an association between minimally invasive surgery and better patient outcomes.

首次通过荟萃分析比较了 I 期肺癌患者的总生存情况，揭示了微创手术与患者更好预后之间的关联。

New evidence reveals equivalent overall survivalfor patients with peripheral ≤ 2 cm NSCLC treated with a sublobar resection compared with lobectomy.

新的证据显示，对于周围型≤2cm的非小细胞肺癌患者，接受肺段切除术与肺叶切除术的总生存相当。

To have confidence in the generalizability of these trials, it is important to perform systematic intraoperative mediastinal and hilar lymph node sampling or dissection during operations for patients with stage I and II NSCLC.

为了确保这些试验结果的普遍适用性，对于I期和II期非小细胞肺癌患者进行手术时，进行系统性的术中纵隔和肺门淋巴结采样或清扫是很重要的。

Use of adjuvant chemotherapy in patients with resected stage II NSCLC plus checkpoint inhibitors, including those patients with ≥ 4 cm, node-negative tumors, improves overall survival. In patients with resected stage IB (≥ 3 cm) and II epidermal growth factor receptor mutant lung cancers, adjuvant targeted therapy improves overall survival. Stereotactic body radiotherapy is the preferred approach to patients with stage I NSCLC who are not considered appropriate candidates for surgical resection.

在接受手术切除的II期非小细胞肺癌患者中，联合使用辅助化疗和检查点抑制剂，包括那些肿瘤直径≥4厘米、淋巴结阴性的患者，可以改善总生存。