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25、1 A iiIDgBB 2A im,iS csco 19JJ 1A iiEWL .&:gMti;Uti&J.EHf9=JDJ&11HB1 2A iiEm, fFlgmo : iiE. DJ.&ttH.M.fiffim., A(*fiS.I$.S)B1m 1B ?RiiItJiSDgBB 2A ?RiiItJiS csco 19JJ 1B iiEt, &ffHHf9=JDJ&11:A:i, gi,RJ.tt1i&JB1 2A iiEt, F II 9tio : )Hi1Jlj(iJH7f9i, tt&jJIJiiEtJ, gDJ.&ttmt5&ffltt/fi&J; XiTIIili*iia S
26、j.gfIt1B1t,M!l, *J1t,*DJ giia, thDJiF II gm 2B iiID 3 iiI XiT*k.ffl, .*ffimB1m, .iiEiiEmffiXi /fR,m.mDJB1, fFmgm#. 1. )1r 7:tID 0 R 2. IIA, IIB!l TC ;:, 1 % ) fFjg II 3. Pj.=p* IIIA Et BIJi5il, 3:54:/g!i TC;: 1% BmpJ-f 4. /fjjJ.=p*III t fro jg IPl tvgJ:)fm:$J:11 5. EGFR3HI I ilkt1f:$o EGFR 1:lGlfiiJ
27、t + g-BtI+ 1Fjg III ilkm$ o EGF 6. ALKifS 7. IV WJ:7C!3li 7%!J illl ;fil!BR1tff 11 3Wllf*IJi.n:ifg: DJ&tHffrJ 2A P100 5l fi i1lifJE:, li5ltM!l * * UJjlJlt frJ 1i:J:tlliJilE:tJiii , JtM!l, ,DJ 1. :5-5tlli!o ROSI , RETJJ1t MET14 5rIl;JEJilk9F:f2NJil IT ilH1f#.tft I tt#o 2. IT A, IT B Wl NSCLC EEJ f1ff
28、0 ;fJTt . fN lttf *115 , IfriJI tIJJ3I;:tlLJlJJtElff ( PD-LJ TC 1%) fl:7J IT tt#o 3. Pff*illA TI.x; illB (T3N2MO) Wl NSCLC sJt1ff 0 5tFzf 7J T3-4Nl. .Elt T4NO rp.tt1gmi (j: gjJIL .:t3Z:E(. .EltI%) t1fffiil-5t. ;fJT.t fN r1tt:f * 115 , lfriJtiJJ-*mf!iJr1ff ( PD-LJ TC 1% EEJmlf6 Jf * illWlJ3.MtffFo.El
29、t-:f4jjij&5:1tffSJ*J15 ,W.1-) fl:7J IT tt#o 4. ;Pff*illA, illB, illC Wl NSCLC EEJt1ff o 5tFzf7J PS=01 1Elff415t, f;1f iiTftlj:tlL fl:7J.Eltm1tfiFoEEJmfi7Jillm#o 5. EGFR .fH8ttOJIli1,Wl NSCLC oJr1ff 0 EGFR lttlff$5t: .tillij 1friJIJE I ti*o EGFR 4lJ.tlJ15tElff$5t: .tiJl5j jt*JE 1tW; ifMIl fifJmtiJ.if
30、:tlL + IJ:! 1:lGm + fl.J1tl +JIW1iB(/ = -t EGFR TKI jjijjL T790M ilI1:.Elt=-t EGFR TKI 11ffIJ&,w.?f) fl:7J illtt#o EGFR 20 -5Hm.mAlFot1t$5t: ff:fit Mobocertinib fl:7J ill tt#o 6. ALK M1t8ttEEJIli1,Wl NSCLC EEJr1t o J1511ffh415t: .tillij l,tJ;JE :?t I ilHt#o 7. lVWlXgzw5J1tf:li NSCLC OJ?Elft 0 ?1ff$5
31、t: JTtj!j i1JltiJJ3jcIj3:tlL(j(1t* J1tlfI:liB*tff fl:7J I tt#; ifJftj!j iiTftljmI&C1t*J1tl*;fQ-ti8 fl:7J I t#; ;fJTj!j 1 Jffil1lftiJf!:t;c(j(1ttifJ1tl;fQiB* fi:7J IT tt#o =1f1ff$7:J: .tifiij 11!ftIJJ3I;if!:tfL :?t T tt*o C#JH0 IT r;, Jffn4$f* rilllf :#lH0 I 0#l+ Jf+wnUH OOFT :.fYIJ,jhf-f.!t, = o#*0I
32、TMWG.W.!#m0ITMWG.em ew.n :#*0IM,WG.WWn:#.0I M O?;.;oj-d4G;:l.i&W.n4t Ijj:f :.fYltl:1.u!, .u!tfl;lIijlf,!UiI?fIqgngfWAI 80 ll;fQTfa 11= JjfflllfjfIJmlrR-if EI FJ; IT m;#o = 1IT ti;f$:o fj.#Jmi8i fIlill i8i . -_-. Im? lIm .,-%,i!t fitA:f,ff.;:ifljjitlk CT 1 -, J ( 1 ) %* (11 i:JHJ ,!j1. HE .g.J nrjJf:
33、 ilt1f =ffi3:l:15!li. CT (2A ) PET/CT 4 J ( 2A ) Ji!;1?tM niJT51I:l:5!li. CT ( 2A ) PET/CT 4 J ( 2A ) :ge.EH1 Ht %:*ml:l:1sMIU :l:1 5!li. CT (2A ) (-. ) -1liJYI=ffi3 I 1.YiiL l-tffl3i:j!j B Jill.!lJ(; CT 1ZI:Illt=ffi3:l: 5!li. CT B Jill (2A ) 1.13:!ir1=IWi ( 2A ) Jliilf:li IIHIl f git:Y.: 4: 1HJt ,
34、EBUS/EUS , 2 BC*11, El:!liPHlf.lJt :Y.:4/I-fj, nliiJ IHEfiJ* j!ru IHEfiJ*tt* t#l3sr*np 1WJm;f& , 1*JRfJU1HIHJliil* JRfj, fWilJl (2A) (2A) Il?J( fzlt W! lm1 ji , J a1IffiI A?R) (2A?R) tl* 2021 Ii&. WHO Hifl :fE1im lii*)111 m:5-?R I J /J a1 HPJ :fE1i tff-i2 1i1J : CD56, Syno, CgA, TTF- I , CK , Ki-67
35、n:fE1i, r:l!jjIJtff-1i1J: TIT-I , NapsinA, P40, CK5/6 () ;$/f Jl/i Bq NSCLC, -f*tff-*m -mtJL1*jjiJJl;Jl:fE1i, lij&i2J, -f*tj* J .iliJfl tij SfJ:riJfJID!, ftllAIS, MIA, 1lf1Jlt.ID! 8q)j j&i, fii:fE1i , R:fE1i, jetal , R:fE1i?R, /f ftID!?R?RID!,.* fJRi!il:Jt:Et)zW1r5Hq,fii?RID! JJT tt19 ; fltAA$tJ.19L
36、 pUm ITF-l, P40 Wi1-fu13.1Uliitff-jjiJ j,Jl:fE1ij&i 2, 3 J #T# Im lIm lIIm Rrp lEltJ.PJf;1( 1-;1(J IT / IffAAuHf EGFR Dl IffAA NSCLC ftziylL mwf!lJloJfflfi 1-4 ) ! 1t. ilUHf,J/GPJf;1( mfj*J1*tWJEWlf*:ill:1f?t BRAF V600E , KRAS *m NGS:JX* T790Iff AARNAA r ttziylU, tlHJ!?tT?tID!m;lilfi (1) , ERBB2 (HE
37、R2) ft ttzl Rrp NSCLC xtTlJH*:it!:1f : EGFR / . METttLV-R :fum (TMB) ,if ftziffi1t, ALK i%tP. il-, ROSJ, RET ffltP. il-R NTRK i%tP. il-;Jjl; 12.;11f:)F PJ (2B ) 5. 6 lRlMET14 jrMrlI9EWC1f:,f&iffi (3) :im:i1Jf!.;Jjl;lZ5Ittziffi:JX;1(= 7&:it1t ift! ff:JX;1( ( NGS) tEJJrp i11i l J( 9=t :ill:11 , ;fHl J
38、H ;zjs:/GPJR , PJm;flJm cfJ lit ctDNA :ill:1Tttziy!U (2B ) I RljJ ffli flF *7G lid;JUIR E:x; :I: j; 17 /f JIH , I HiF*tM& 4S *ffl NGS 1st#: It ;ji19lUprlill12 Jz fftiff (TMB) ar (2B) 5.6 J tffi cf/ . *mm./ .mg rlill DNA ( dJctDNA) :itt 17 EGFR E!t1 :ll itT Jti EGFR 12, 1t f jlJlIJ 7-15 ); -/ =1l.: E
39、GFR-TKIs ALK IM!& ROSI 1l9! ifuH: ,itT. J!tX.jI!Xm:itt17 EGFR jPIIJ (2A ) 1790M t.&ilJllJ 12 10 0l1-11)4fflif*iIJ Ji!titT, Jti17 c!ctDNA EGFR T790M t.&ilJllJ 10. 15 1 lit/F*fflfk,r5gli1t1-!tjlJl PD-L1 7&:it ( 1 ) /JiIBJJ!Bifjtrnjafi II A, II B WlF/. I A, I BWlF/JgrnDmHmeSJj8:ff TI A, E:-=f* Im lIm T
40、I B WI ,1r SCLC I A, IB E:-=f* fijIHrljtUrjJPt f;J+ nrIWJ&w.I% 1iit -QJ 1t * r C;fJL *lf A 4itl WJ NSCLC ,1it1r r,f;fl3nrJ!ft=l* ( 2A) WJ ) BffJlrg:IJ 11:nrjJnH1Jf+ .1t* r (.). nHw.ml3mt=l I1HrjJ P -I-tJJ I +Hi/l n H w. r,f;f 13 * (2A) fjilft=l* ( 2A ) JJ!E:-=f jL f * 1 rtJ fiX M 1B 17 ( SBRTI *fflf
41、HGill1ij:17t;!Z* *,1r SABR ) 1 1-6 J ( 2A) :g; hfJi jL f* 5E rtJ 1i!l. fi 1-6 1 /fE:-=f ( 2A) *, IT A, illlft-* ffJit:gIJ ttRiIi !;J + B rlWIEd1%tl* B iUrt*r(;jjlT,V,-Ifj ) ITAAA: * IT B tVJ , riH3 ( l) BgffJittfU11)W-m+ Hi1W l & 8Ji1J NSCLC iJlflrt*T (m) B.JffJittfUtl:HT/i W.1%tfBi5ifj3* m flJd t f
42、i A. -m flff, + )JT/iIl.&w.I%tl*Bi5mt:l* ;fi/1-*Fo, lWJiflj:l3j:; (2B) 7J 1l-1 + ITBm: 118Xi1JfI.Mt fi 7 Jf!mtmW Jiflff (PD-Ll m t:I Te;: 1% ) o JnrU-*J3.*Fot&illl jJ EGFR fiN :lHS/1 ,:j!,j. * i=1- Jr. (4tIlWJ 1-1: TFn ) !Ix 5 Jr. 4tIl WJ 1flfi 8. 9 tZ * ; -6 1 jj:fi 1-4 /F.ill!ft- mfiFn1118;Ji)j1-1
43、:ff *, Ill :!V Jj)( 1-1: T (-=: tt.ill! ,Jf J1)( fi / .ill!,Jf ( 2A ilE:Jm ; ftltGi*Bi5 14 liltiJ;1Js.iap)(ff + 1-1:JT) 11-t, 2B) 11 -14 . ijJqJ*mAlIIB (T3N2MO) /JglIlJlB!MHeSJ)8IT Im:j lIm:j 1iHIM Ilffipj: l liih pj: ill A fj:J illB T3-4Nl .!1X: T4NO f* (2A t:R) +:tmlfljJ if7i:tml flJJ itrr tiJ: rr
44、 + $ M ( T3N2MO) HiP.tj1;j)il (1BJliil itrr ( 1 t:R ) tLH rj tl: f* (2B t:R) ffiMiJ N( PITI ,x.!1X:) tiJ:it rr 1 J ttUi1I1:f* J , ilJ Ilffipj: l CT, EBUS/EUS fl:EJK1t1:tJr:tmlUMrjrr ( l:lliM:1 PD-Li TC:; 1% ) a 2J .!1X:f%m*fj-WIl;f; ( rff B ts:5tM ) T3-4N 1 RiP.t j1;j)il jfJi:tmlflfJtfJ:itrr + f* +
45、W if1l1:tfJ: it rr 1 J :tmlflJJit rr 3 4 IPJ -HiP Pi-1;i;J 13 TIJG IPJ f* ( 2A t:R) + 4m!l:b *JfIl fm)$:;r; IPJ HiP u -I-j;I;j 14 it rr S-6 (1 t:R) iiXJ3 IIffipj: N2 f*W ( 2A t:R ) + if7i:tml flfJ it rr tiJ:1 7 + 1t111f%#t B :tmlflfJitrr *JtiJ: f* :tml flJJ1t rr tJ(f$(#tB rr c (2B) *JtfJ:rr h, c (2B
46、 t:R ) jII ll 9;fI1 2cm), l:lliMPJ Wyrjl1:lPJtJ7tiJ:itrr1. 7 JGtJ ( 1 t:R) _liiA,III til.ft + i , iiJ flft (111. lo) a 2 1i!zft + J1tft , (2B) Ilili5f: N2 $Yw-ml31$, J:vtMPJg%JJ Ilili5f:N2 1:V1 Wl :3C ;1-1 efJ ,w rl 11 tJJ d 7/(:rntrf;JJIJl.f&iIJl1 EGFR ilN!X ,wrliEI6Jtt-h:J(t;:rT1. 7 WT-tIIlfIJJ1tf
47、t n!zft + Cl ) 7/(: :mfIJJ1tft 7/(:)-n!zft b, c (2B) t&1ill1l6JtVn!z1tft1. 7 (I ) Jt1:lt;fIJ jtltt:JJ1:f1: jg Ill tVn!z1tft)-Jl 1l ft 18-10 ,wil 11 7/(:, ;j!f , 7/(: ,wil tE-7I(, ;j!f , 71( )-;ffi- (-tIIlWJ1-t )-aF!1-X;m: rr:fIJJlft 13. 14 ir)-) !1-X;*Err:-tIIl J1Mlft 11. (IB )12J ji a J1:j=fJYfff P
48、I:of# fi MJtIJ 1-tfiFn DX/G ijf1-tfii!J *=Fn l:j!f 0 b *=WT*1-rf5lTJtlJ1i)(fi , *=FnnJBhJ1)(fi0 c *=JI5ffi;J! N21lJ()1it#JI51i)(fi (2B ), mjjJYHVfJE*JlJ#JI51i)(fi:ff:1Hiio d $ /GPI:of#fiA , fiB , mcM/JWlJjHmttml:ff i4ll:5to 1qJ=#:ill A, illB, me F/JgrnDBlmfrSljEHJ I tU lIft:jI. -+-1:if /GriT IJ.J PS
49、=2 mAW! msM, illCM imM SCLC /GPJ1:) ill AM, fis M , mcM NSCLC PS=O-l iIIIi ill 1. $*4rnllAiti1: 2. ;Wtl:filJtH)(1-tfi 1. 2 jj)(ff : E%i%J5!lUIiJI%iffil 5iil.J1J(ff1-6 ; &lI!ft# E.ti!l!Kjj)(fi7. J 1-tff : JWiB + it1iiEl=tt JWi( /12m + ,f3M JiWf + W1tl! JlWiErilX12m + *rlUl (flli) 3. ltt.lGiJjt.Qim-W:1g filJiVti)(1-tffFn ItJ mlitlfrtff I. 11 I10. J. Ffm-1-tff +1i!Xft 121 *f#lIJ.!fJ.m ( 2A ) 1-tff: JlWiB + w: JlWim + IHflllil iJ)(fi: =%iJ)(7l 3 I 2. MDT t1.1: sp: fir i. frtffFn II$M T-# MJ PJ1=rtl:, 1l1$IJjG :tl:t1J , 1.T-MT Fn:of*=#tff -W7j IpJiV.ilX Ffm-71x1-tff Fnll9:JLI6iift ff 13 J 1iT*III
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