Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

Digestive system cancers are very prevalent globally. Among these, human epidermal growth factor receptor 2 (HER2)-positive gastric cancer, colorectal cancer, and cholangiocarcinoma are tumors that require particular attention. HER2-targeted antibody-drug conjugates (ADC) deliver cytotoxic drugs specifically to tumor cells via HER2 monoclonal antibodies, representing a breakthrough in the precision treatment of HER2-positive tumors and a milestone in oncology therapeutics. Currently, trastuzumab deruxtecan and disitamab vedotin have been approved by the National Medical Products Administration for the treatment of advanced gastric cancer. However, with the expanding clinical use of ADC, drug-related adverse reactions have been increasingly observed, impacting patient prognosis and quality of life. Based on clinical trial evidence from China and abroad, and integrating multidisciplinary expertise, this consensus emphasizes a “physician-led and patient-engaged” education model, defines key aspects of clinical management and patient education for HER2-targeted ADC-related adverse reactions, and provides evidence-based support for standardized management in primary healthcare settings.

OBJECTIVE To provide standardized guidance for the clinical application and management of biosimilars， and promote their widespread and rational use in clinical treatment. METHODS The design， planning， and drafting process as well as the full report of Evidence-based Guideline for the Management of Clinical Application of Biosimilars in China （2024 Edition） followed the WHO Handbook for Guideline Development （2nd edition）， which fully considered the best current evidence from evidence-based medicine， multidisciplinary expert experience， and patient preferences and values. Grading of Recommendations Assessment， Development， and Evaluation （GRADE） approach was adopted to evaluate the quality of evidence and determine the strength of recommendations. RESULTS & CONCLUSIONS Evidence-based Guideline for the Management of Clinical Application of Biosimilars in China （2024 Edition） presented 10 recommendations including 7 strong recommendations and 3 weak recommendations. The recommendations covered the entire process of clinical application and management of biosimilars. Medical institutions and relevant health regulatory departments can refer to this guideline for the scientific management of the extrapolation of unapproved indications of biosimilars. Healthcare providers can refer to this guideline for pre-treatment assessments， patient education， pre-treatment regimen before administration， and dosage regimen adjustments. Multidisciplinary medical teams can refer to this guideline to provide pharmacovigilance and patient management throughout the treatment process.

For advanced non-small cell lung cancer(NSCLC)patients with negative driver gene mutations,chemo-therapy has always been the standard treatment option,and immune checkpoint inhibitors(ICIs)provide other treatment op-tion for these patients.At present,the first-line treatment can choose chemotherapy,anti-angiogenic drugs or immunotherapy.Although the initial treatment can achieve a certain clinical curative effect,disease progression or treatment failure is eventually unavoidable.The second-line and subsequent treatments have poor efficacy and more effective drugs are needed clinically.An expert panel of respiratory medicine,pathology and medical oncology organized by Expert Committee on Non-small Cell Lung Cancer of the Chinese Society of Clinical Oncology conducted an in-depth discussion on evidences of clinical studies for second-line treatment of NSCLC patients with negative driver gene mutations,aiming to provide guidances for Chinese clini-cians in choosing second-line treatment for NSCLC patients with negative driver gene mutations.

The standard clinical practice of managing the non-small cell lung cancer(NSCLC)with epider-mal growth factor receptor(EGFR)exon 20 insertion(ex20ins)mutations was elaborated in Chinese expert consensus on non-small cell lung cancer with EGFR exon 20 insertion mutations(2023 edition),and this rare subset has gradually attracted attention recently.With the deepening of treatment area exploration and the approval of new targeted drugs,there are more options for the diagnosis and treatment of EGFR ex20ins positive NSCLC patients.Therefore,based on the previous version of consensus,the expert panel has updated this consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data,and combined with the experts'own clinical experience.The updated recommendations includes disease congnition,testing methods,therapy and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation,in order to provide better medication reference for clinical physicians.

The surgical treatment of renal tumors has always been a challenge in the field of urology.Although traditional two-dimensional imaging provides certain anatomical information,it is limited in accurately locating tumor positions,aiding in surgical planning,and assessing risks.Three-dimensional(3D)reconstruction technology offers a more intuitive and detailed representation of anatomical structures,en-abling surgeons to better understand the relationship between tumors and surrounding tissues and develop more precise and personalized surgical plans.Based on relevant medical evidence and expert consensus,the Urological Tumor Committee of the Chinese Anti-Cancer Asso-ciation and the Experts Committee on Renal Carcinoma of the Chinese Society of Clinical Oncology formulated the"Expert Consensus on the Application of 3D Reconstruction in Renal Tumor Surgery,"which aims to standardize the application of 3D reconstruction in renal tumor surgery to enhance clinical diagnostics and treatment,ultimately benefiting patients.

Corona virus disease 2019(COVID-19)infection has become a major public health issue affecting human health.The main goal of epidemic prevention and control at the current stage in China is to"protect people's health and prevent severe cases".Patients with lung cancer who receive antitumor therapy have low immunity,and the risk of severe illness and death once infected is much higher than healthy people,so they are vulnerable to COVID-19 infection.At present,less attention has been paid to the prevention and treatment of COVID-19 infection in patients with lung cancer in domestic guidelines and consensus.Based on the published data in China and abroad,we proposed recommendations and formed expert consensus on the vaccination of COVID-19,the use of neutralizing antibodies and small molecule antiviral drugs for patients with lung cancer,for physician's reference.

Microsatellite instability (MSI) which resulted from the deficiency of DNA mismatch repair (MMR), is an important clinical significance in the related solid tumors, such as colorectal cancer and endometrial cancer. There are several methods to detect MSI status, including immunohistochemistry for MMR protein, multiplex fluorescent polymerase chain reaction (PCR) for microsatellite site and MSI algorithm based on next generation sequencing (NGS). The consensus elaborates the definition and clinical significance of MSI as well as the advantages and disadvantages of the three detection methods. Through this expert consensus, we hope to promote the screening which based on MSI status in malignant tumors and improve the acknowledge of clinicians about various testing methods. Thereby, they could interpret the results more accurately and provide better clinical services to patients.
Antineoplastic Agents ; administration & dosage ; adverse effects ; therapeutic use ; China ; Colorectal Neoplasms ; genetics ; pathology ; Consensus ; DNA Mismatch Repair ; DNA Sequence, Unstable ; Delivery of Health Care ; standards ; Endometrial Neoplasms ; Female ; Humans ; Immunohistochemistry ; Microsatellite Instability ; Microsatellite Repeats ; Microscopy, Fluorescence ; Polymerase Chain Reaction ; Practice Guidelines as Topic

The liver is the most common anatomical site for hematogenous metastases of colorectal cancer, and colorectal liver metastases is one of the most difficult and challenging points in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, improve the resection rate of liver metastases and survival. The revised Guideline includes the diagnosis and follow-up, prevention, MDT effect, surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, and with advanced experience, latest results, detailed content, and strong operability.
Chemotherapy, Adjuvant ; China ; Colorectal Neoplasms ; pathology ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnosis ; secondary ; therapy ; Neoadjuvant Therapy ; Practice Guidelines as Topic