摘要：由国际肺癌研究协会（IASLC）主办的2025年世界肺癌大会（WCLC2025）于2025年9月6日在西班牙巴塞罗那盛大召开。作为肺癌及其他胸部恶性肿瘤领域全球领先的多学科肿瘤学盛会，WCLC致力于传递该领域最前沿的诊疗进展，为世界各地的专家学者及研究者提供分
由国际肺癌研究协会（IASLC）主办的2025年世界肺癌大会（WCLC2025）于2025年9月6日在西班牙巴塞罗那盛大召开。作为肺癌及其他胸部恶性肿瘤领域全球领先的多学科肿瘤学盛会，WCLC致力于传递该领域最前沿的诊疗进展，为世界各地的专家学者及研究者提供分享前沿研究成果、促进合作交流的平台。
2025年9月8日，IASLC 主席换届授旗仪式正式举行，值此换届传承的重要时刻，《肿瘤瞭望》特邀国际肺癌研究协会（IASLC）卸任主席、比利时安特卫普大学医院Paul Van Schil教授与新任主席、同济大学附属东方医院周彩存教授展开深度对话，两位专家立足东西方临床实践的差异，探讨肺癌领域从诊疗策略到创新技术的前沿图景与实践方向；同时，围绕IASLC过往工作成果展开回顾，并对未来发展方向进行展望，为全球胸部肿瘤领域的持续发展注入新的思考与动力。
授旗传承 展望新篇
2025年9月8日，2025年世界肺癌大会（WCLC2025）第二场主席研讨会成功举办，会议期间，备受瞩目的IASLC主席换届授旗仪式正式举行——比利时安特卫普大学医院Paul Van Schil教授圆满完成任期，正式卸任IASLC主席一职。Paul Van Schil教授坦言卸任时满怀感恩，称服务IASLC是毕生荣幸，虽自身背景及专攻的胸外科在协会内相对小众，但证明人人皆有上升路径。回顾两年任期，Paul Van Schil 教授提及IASLC五大核心进展：第九版肿瘤分期项目推进、协会两本期刊稳步发展、2024年五年战略规划启动、全球合作深化及“肺癌 360”（Lung Cancer 360）教育平台建设；同时，他也分享了IASLC 50 周年庆典等珍贵回忆。他对新任主席周彩存教授充满信心，不仅分享了任职期间的三点工作感悟。更强调需延续IASLC无壁垒的友善精神、坚守协会高标准。最后，他感谢大家给予的任职机会，并表态未来将继续支持周教授，共同推进攻克胸部肿瘤的使命。
Paul Van Schil教授
随后，Paul Van Schil教授将象征IASLC学术使命与引领责任的旗帜，郑重交予同济大学附属东方医院的周彩存教授。这一交接不仅是IASLC学术传承的关键节点，更标志着协会正式开启由中国专家领衔、携手全球同仁共促胸部肿瘤诊疗事业进步的全新篇章。
IASLC 主席换届授旗仪式
授旗仪式后，周彩存教授发表就职讲话。他首先向Paul Van Schil 教授表达感谢，既肯定其任职期间的卓越领导力与突出贡献，也致谢这段历程中结下的珍贵友谊；同时坦言，能以新任主席身份站在这里，是人生一大荣耀。周彩存教授分享，自己的抗癌事业始于上海，而跨越全球的工作经历让他深刻领悟 “抗癌无国界”—— 这正是IASLC的核心精神。他指出，IASLC作为汇聚110个国家、8000余名成员的共同体，始终以多学科协作为根基，致力于成为肺癌与胸部肿瘤领域的全球权威，为患者提供最优的诊疗与预防服务。
针对未来工作，周彩存教授明确，为实现 “本世纪全球攻克肺癌及其他胸部肿瘤” 的愿景，IASLC将聚焦四大核心领域：整合科研力量强化国际化与多学科属性、推动创新并扩大全球多中心试验、缩小医疗差距且拓展教育项目、普及肺癌人文认知并优先患者声音。他承诺将倾尽全力服务成员，呼吁众人携手协作，共同推动肺癌成为全球可治愈疾病。
周彩存教授
中外视角，共瞻前沿
肿瘤瞭望：请您结合临床实践经验，分享早期非小细胞肺癌患者中靶向治疗的核心临床价值
周彩存教授：在IB-IIA期非小细胞肺癌（NSCLC）患者完全切除术后，我们会经常使用辅助靶向治疗，例如EGFR-TKIs，ALK-TKIs等，其中，奥希替尼和阿来替尼已获批用于早期NSCLC治疗，根据相关III期临床试验结果，这类药物能显著提高患者的无病生存期（DFS）。但在新辅助治疗阶段我们很少使用靶向治疗药物，因为这个阶段患者很难达到完全缓解，所以我更倾向于在患者完全切除术后给予辅助靶向治疗。
Paul Van Schil教授：我完全同意周教授的观点。我想补充一点，对于可手术切除的早期NSCLC患者，实现R0完全切除至关重要。因此，对于明确可切除的I期、II期NSCLC患者，我们应优先选择手术治疗，不能因靶向治疗而耽误患者的手术时机。术后判断是否需要辅助治疗与患者整体生存获益相关，通常高危患者需要辅助治疗，比如存在淋巴结受累或肿瘤体积较大的患者。此外，需要说明的是，欧洲患者的ALK、EGFR突变率低于亚洲患者。但在某些情况下，对于程序性死亡配体 1（PD-L1）阳性的患者，我们也会考虑辅助免疫治疗。
Professor Zhou: So we use adjuvant targeted therapy a lot after complete resection for stage IB to IIA NSCLC, we have EGFR-TKIs, and we also have ALK inhibitors. Moreover osimertinib and alectinib have been approved and are quite effective in early-stage lung cancer. According to phase III trials, they significantly improve disease-free survival. In the neoadjuvant setting, we seldom use TKIs in my opinion, because complete response is quite rare in this phase. So l prefer to give adjuvant TKIs to patients after complete resection.
Professor Paul Van Schil: I completely agree with Professor Zhou. Let me remind you that when you operate on a patient, it's important to achieve a complete R0 resection. For clearly resectable stage I and II NSCLC, we should proceed with an operation first, not to lose any patients due to neoadjuwant therapy. After the operation, we decide whether adjuvant therapy is necessary, usually for high risk patients , for example, those with involved lymph nodes or larger tumors. Additionally, we note that we have fewer ALK and EGFR mutations in Europe than in Asia. But in some cases, we also consider adjuvant immunotherapy when PD-L1 is positive.
肿瘤瞭望：您认为如何将靶向治疗与手术有机结合，进一步优化可切除NSCLC的治疗效果？
Paul Van Schil教授：目前，欧洲国家对于早期NSCLC患者仅可在术后适用靶向治疗，这是唯一可报销的治疗方式，我们需遵循欧洲药品管理局（EMA）的规定。而靶向治疗在新辅助治疗领域临床应用相关研究结果刚刚公布，目前尚未获批术前使用新辅助靶向治疗的治疗方案。遗憾的是，对于需要诱导治疗的EGFR阳性患者，我们仍需采用化疗，但希望未来这一情况能有所改变。不过，联合治疗（如手术与新辅助治疗、辅助治疗或围手术期治疗相结合）前景广阔，这将是未来短期内的研究重点方向。
周彩存教授：在临床实践中，对于IIIA期T4亚型患者，我更倾向于在新辅助治疗阶段使用靶向治疗，且会将靶向治疗与化疗联合应用。相比单纯化疗，这种联合方案能更轻松、更有效地实现肿瘤降期。因此，个人认为，对于IIIA期T4亚型或N1期患者，可在新辅助治疗阶段给予靶向药物，必要时可联合化疗。
Professor Paul Van Schil: Regarding targeted therapies, currently, we can only administer them after the operation, as this is the only reimbursed approach. We follow the decisions of the European Medicines Agency (EMA). The results of the neoadjuvant have just come out, but we don't have any permission now to use neoadjuvant TKIs regimens before the operation yet. Unfortunately, for EGFR-positive patients who need induction therapy, we still have to use chemotherapy, but we hope this will change in the future. But the combination therapy , such as combining operation with neoadjuvant, adjuvant, or perioperative therapy seems very promising, but this is something for the near future.
Professor Zhou: So I prefer to use targeted therapy in the neoadjuvant setting for patients with stage III T4. We can combine targeted therapy with chemotherapy in the neoadjuvant setting. Tumor downstaging is easier and better with this combination than with chemotherapy alone. In my practice, I prefer to give patients with stage III T4 or N1 neoadjuvant TKIs, maybe plus chemotherapy.
肿瘤瞭望：请您结合临床实践，分享下当前临床中，可切除局部晚期NSCLC的“可切除性” 界定标准主要有哪些？其中仍存在哪些尚未达成共识的争议点？
Paul Van Schil教授：当我们谈论局部晚期非小细胞肺癌时，指的是IIIA期和IIIB期患者。为此，我们与欧洲癌症研究与治疗组织（EORTC）共同制定了判断肿瘤可切除性的标准。可切除病例指外科医生有把握实现R0完全切除的情况，因为这是手术治疗的首要目标。而明确不可切除的病例包括bulky N2期病变（如肿瘤或肿大淋巴结压迫上腔静脉，或存在多水平bulky病变），这类患者即便接受新辅助治疗，大多也不符合手术切除条件，仅有少数例外情况。
在这两类情况之间，还存在一个“灰色地带”，例如多站N2淋巴结转移（N2b）患者右侧第2、4组淋巴结等多组小体积淋巴结转移的情况，这类患者可能具备手术切除条件。对于这类病例，我们会先进行新辅助治疗，再评估是否进行手术切除。因此，肿瘤可切除性的定义仍在不断完善中。
回顾多项大型临床试验（如针对不可切除病变的PACIFIC研究），我们发现这些研究均未对“不可切除”给出精准定义；同样，新辅助治疗或围手术期治疗相关试验虽纳入了“可切除”患者，但也未明确“可切除”的具体标准。这一问题亟待在未来得到明确。
周彩存教授：我完全同意Paul Van Schil教授的观点。判断患者肿瘤是否可切除时，肿瘤的位置和范围（肿瘤负荷）是关键因素。同时，我们必须听取胸外科医生的意见，他们在肿瘤可切除性评估中起着重要作用。
Professor Paul Van Schil: That's a good question. When we talk about locally advanced non-small cell lung cancer, we are talking about stage IIIA and IIIB disease. For this, we have developed criteria with the European Organization for Research and Treatment of Cancer (EORTC) to define what is resectable and what is unresectable. Resectable disease includes patients in whom the surgeon is confident that he can obtain a complete R0 resection, because this is the primary goal of surgery. Then you have the clearly unresectable cases include, for example, bulky N2 disease: if lymph nodes are as large as the superior vena cava, or if there is multilevel bulky disease, most of these patients do not qualify for surgical resection, even after neoadjuvant therapy. There are some exceptions, but they are rare. Between these two categories, there is a "gray zone"—for example, multiple N2 disease with small lymph node metastases (e.g., stations II and IV on the right side), which may be resectable. In such cases, we would like to start with neoadjuvant therapy followed by surgical resection. So this is an ongoing process of defining what is resectable and what is unresectable. After seeing all the large trials, for example, the PACIFIC trial that focused on unresectable disease did not provide a precise definition of "unresectable." Similarly, trials of neoadjuvant or perioperative therapy included "resectable" patients but also lacked a precise definition. This is something we need to clarify in the near future.
Professor Zhou: I totally agree with what professor Paul said. When deciding whether a patient is resectable or unresectable, the tumor's location and extent (tumor burden) are key factors. We must listen to the opinions of thoracic surgeons, they play an important role in determining resectability.
肿瘤瞭望：您认为新辅助治疗后再分期策略的核心临床价值与局限性分别是什么？
周彩存教授：再分期至关重要。我们需要开展多项检查，如增强计算机断层扫描（CT），甚至通过活检评估N2/N3期淋巴结状态也是很关键的手段。在中国，我们常采用超声支气管镜（EBUS）进行再分期检查，同时还需进行脑部磁共振成像（MRI），这些检查都能帮助判断患者肿瘤是否可切除。再分期对患者后续治疗方案选择至关重要，因此我们需与胸外科医生充分沟通，听取他们的专业意见。
Paul Van Schil教授：纵观多项大型新辅助治疗或围手术期治疗研究均存在一个问题，其再分期评估仅通过CT扫描完成，未强制要求进行PET-CT，而我们知道单纯CT检查的可靠性并不高。在临床试验之外，我们的常规做法是：先通过超声支气管镜（EBUS）确认N2期病变，再启动新辅助治疗；治疗后，通过纵隔镜检查进行纵隔再分期。其中，对于仍存在N2期甚至N3期病变的患者，若强行进行手术，预后会很差。因此，这类患者更适合接受放疗联合免疫治疗，或放化疗。
Professor Zhou: Restaging is very important. We need to conduct multiple tests: contrast-enhanced CT scans, even biopsies to evaluate N2/N3 status—this is really critical. In China, we often perform endobronchial ultrasound (EBUS). We also need to do brain MRI—all these tests help determine whether a patient is resectable or unresectable. Restaging is essential, but we also need to communicate with thoracic surgeons and listen to their opinions.
Professor Paul Van Schil: The problem with large neoadjuvant or perioperative therapy trials is that restaging was only done via CT scan, not PET-CT—and PET-CT was not an obligation to do it. We know CT alone is not very reliable. Outside of clinical trials, our usual approach is to confirm N2 disease via EBUS first, then start neoadjuvant therapy. After therapy, we perform mediastinoscopy. I truly believe that patients with persistent N2 or even N3 disease have a poor prognosis if we proceed with surgery. So it's probably better to give them radiotherapy combined with immunotherapy or chemo-radiotherapy instead.
肿瘤瞭望：新辅助治疗后再分期患者接受新辅助治疗后，需达到哪些影像或病理标准，才能判定为“可转化手术”？
Paul Van Schil教授：目前尚无充分数据对此进行明确界定。正如我之前提到的，所有新辅助治疗或围手术期治疗试验纳入的都是所谓的 “可切除” 患者，我们尚不清楚部分初始不可切除的患者是否能通过治疗转化为可切除状态。
将初始不可切除病变转化为可切除病变，是胸外科医生的理想目标，但这需要更多研究数据支持。现有部分数据显示，新辅助治疗后全肺切除术的使用率有所下降，但这一结论尚未得到证实。目前已有部分试验即将启动，这些试验会纳入多学科团队（MDT）判定为初始不可切除的患者，给予新辅助治疗后再重新评估可切除性。例如，荷兰开展的INCREASE试验，采用化疗、免疫治疗与放疗联合的方案。值得一提的是，今年4月我访问中国时了解到，中国也在开展相关研究，研究团队通过减少了新辅助化疗联合免疫治疗的周期数，并降低了放疗剂量以探索最优策略。他们告诉我，研究中患者的病理完全缓解（pCR）率达到了40%-50%，相比单纯新辅助化疗有显著提升。未来我们必将在此基础上进一步深入研究。
周彩存教授：根据我们的研究观察，新辅助化疗联合免疫治疗能实现出色的病理完全缓解率，对于局部晚期NSCLC患者的病理完全缓解率约为20%-24%，这一结果已十分可观。
在我的临床实践中，通常会先给予患者新辅助化疗联合免疫治疗，再通过再分期评估患者肿瘤是否转化为可切除状态。同时，我也会与胸外科医生深入讨论，确定哪些患者适合手术切除，哪些患者应接受同步放化疗后再进行免疫维持治疗。
Paul Van Schil教授：然而目前仍存在一个问题亟需探索，即对于新辅助治疗后未达到可切除的患者，后续应如何处理？是否需要追加治疗？若需要，应选择何种治疗方案？这些问题目前尚无答案。
周彩存教授：众所周知，KRAS突变、STK11/KEAP1 突变、甚至 SMARCA4 突变等生物标志物与化疗免疫治疗疗效不佳相关，所在临床实践中，能获取足够的肿瘤组织进行相关生物标志物检测，对临床实践将具有十分重要的指导意义，对于携带这类标志物的患者，我们不会给予新辅助化疗联合免疫治疗，而是仅采用同步放化疗联合后续免疫维持治疗的方案。
Professor Paul Van Schil: We don't have good data on this yet. As I mentioned, all neoadjuvant or perioperative therapy trials included "resectable" patients as they call it, we don't really know if some initially unresectable patients can become resectable. It's our dream as thoracic surgeons to convert initially unresectable disease to resectable, but we need more data. There is some data showing fewer pneumonectomies after neoadjuvant therapy, but we are not certain about this yet. Some trials are about to start: they will enroll patients deemed unresectable by the multidisciplinary team (MDT) at baseline, administer neoadjuvant therapy, then reevaluate resectability. For example, in the Netherlands, there is the INCREASE trial, which combines chemotherapy, immunotherapy, and radiotherapy. I visited China in April and learned that some studies are ongoing—they reduced the number of neoadjuvant chemoimmunotherapy cycles and the radiotherapy dose. They told me the pathological complete response (pCR) rate reached 40-50%, which is a real improvement compared to neoadjuvant chemotherapy alone. This is something we definitely hope to build on in the future.
Professor Zhou: Neoadjuvant chemoimmunotherapy (chemo + IO) achieves very good pCR rates. From what we've observed, the pCR rate is around 20-24%—which is not bad for locally advanced non-small cell lung cancer. Maybe we can administer neoadjuvant chemo-immunotherapy first, then perform restaging to evaluate if the patient has become resectable or remains unresectable. That's my usual practice. But I also have extensive discussions with our thoracic surgeons to decide which patients should be resected and which should receive concurrent chemo-radiotherapy followed by IO maintenance.
The problem remains also is that for patients who do not achieve complete resection after neoadjuvant therapy, what should we do next? Should we give additional therapy? If so, what kind? We don't have answers yet.
Professor Zhou: If we have enough tissue, we can test for biomarkers such as KRAS mutation, STK11/KEAP1 mutation, even SMARCA4 mutation. We know these biomarkers are associated with poor efficacy of chemo-IO. So for patients with these biomarkers, we never give neoadjuvant chemo-IO, we only give concurrent chemo-radiotherapy followed by IO maintenance.
肿瘤瞭望：请您结合临床实践经验与最新研究进展，分析下“治疗降级”在驱动基因阳性NSCLC中的应用可行性（如适用人群、疗效与安全性平衡）？该策略对改善患者生活质量、降低经济负担是否有实际意义？
周彩存教授：目前关于“治疗假期” 的讨论很多，但我认为 “癌症从不会放假”。理想情况下，我们应在病情稳定的前提下降低治疗强度。不过，对于部分肿瘤缓解效果极佳的患者，我们可以通过循环肿瘤DNA（ctDNA）监测病情：当ctDNA检测结果为阴性时，可给予患者短期“治疗假期”，暂停治疗后每1-2个月接受一次ctDNA检测；若ctDNA检测结果转为阳性，再重启治疗。
尽管这一思路非常好，但目前在中国ctDNA检测尚未得到充分验证，且检测费用较高。因此，目前“治疗假期”不应适用于所有患者，我们仅为部分符合条件的患者制定该方案。
Paul Van Schil教授：我完全同意这一观点。目前我们尚无法准确筛选出新辅助治疗后可停止治疗的患者，这仍是一个待解决的问题。在部分新开展的研究中，研究人员会增加ctDNA检测的频次，因为仅在单一时间点采集一次样本远远不够，需要在多个时间点进行检测，对比ctDNA水平的变化趋势（如是否下降、何时持续阳性等），再据此制定治疗决策。因此，多次ctDNA检测至关重要。
Professor Zhou: There is a lot of discussion about "Treatment Holidays". But I would say "cancer never takes a holiday." Ideally, we should reduce treatment intensity up to disease equation.However, in some cases where patients achieve a very good tumor response, we can use circulating tumor DNA (ctDNA) to monitor the disease. When ctDNA becomes negative, maybe we can give the patient a short period of holiday,stop the treatment, then follow up with ctDNA testing every 1-2 months. If ctDNA turns positive, we can restart treatment. This is a very great idea, but ctDNA testing is not yet well-validated in China, and it's not cheap. So currently, treatment holidays should not be applied to all patients，we just select the right patients for treatment holiday.
Professor Paul Van Schil: I completely agree. We cannot yet accurately select which patients can stop treatment after neoadjuvant therapy. This is still a work in progress. In some new trials, more ctDNA testing will be conducted—because it's not enough to take one sample at one time; you need to test at multiple time points, compare whether it goes down or not, or when it stays positive or not. and then make decisions. So multiple ctDNA samples are really necessary.
肿瘤瞭望：请您从全球视角出发，谈谈当前不同地区、不同经济水平的肺癌患者，在获取靶向治疗时主要面临哪些障碍？有哪些可行方向能改善这种可及性差异？
Paul Van Schil教授：这是一个很重要的问题。获取靶向治疗主要障碍如下：首先，靶向药物价格昂贵；其次，不同地区药物的推广应用和可及性存在差异；此外，临床指南也存在差异。我们在国际肺癌研究协会（IASLC）董事会会议上讨论过这一问题：我们需要明确靶向治疗可及性方面存在的差距。
巴西就艾滋病病毒（HIV）药物提出了一项有趣的提案：开展区域性及特定国家层面的评估，以找出这些差距并评估药物定价。具体而言，巴西已确定了一份被视为必需的药物清单，并致力于解决这些药物的成本问题。目前仍有大量工作有待完成，对于中低收入国家（LMICs）而言更是如此，我们坚持这项努力，因为这些地区的问题比西欧地区要严峻得多，这促使制药公司同意降低价格，进而确保了每个人都能获得艾滋病病毒（HIV）药物。我们希望这一模式也能应用于靶向治疗、免疫治疗及其他抗癌治疗领域。
周彩存教授：这是一个难题，目前尚无完美解决方案，但我们无法接受全球仅有少数人能获得最佳癌症治疗的现状。我们需要提高这些治疗手段的可及性，但这并非易事，经济水平和治疗费用是提升可及性的主要障碍。
Paul Van Schil教授：我们还需注意，在许多中低收入国家，大多数患者确诊时已处于IV期（转移性疾病），因此他们从一开始就不符合围手术期治疗的条件，这类患者更加需要靶向治疗等创新药物。
Professor Paul Van Schil: This is a major problem. First of all, the cost of medications is not cheap. Second, there are barriers in implementation and distribution. Additionally, there are gaps in clinical guidelines. We discussed this at IASLC board meetings: we need to identify gaps in access to targeted therapies.
Brazil has put forward an interesting proposal concerning HIV drugs: conducting regional and country-specific assessments to identify these gaps and evaluate drug pricing. Specifically, Brazil has identified a list of medications deemed essential and aims to address their cost issues. Substantial work remains, particularly for low- and middle-income countries (LMICs). They persisted in this effort because the problem was far more acute in these regions than in Western Europe, which led to pharmaceutical companies agreeing to lower the prices. This ensured that everyone could access HIV medications. We hope the same approach can be applied to targeted therapies, immunotherapies, and other anti-cancer treatments.
Professor Zhou: This is a tough question. We don't have a perfect answer yet, but we cannot accept that only a small number of people in the world can access the best possible cancer care. We need to increase access to these therapies, but it's not easy—economy and cost are major obstacles to improving accessibility.
Professor Paul Van Schil: We should also not forget that in many LMICs, most patients are diagnosed at stage IV (metastatic disease). So they do not qualify for perioperative therapy in the first place.
肿瘤瞭望：近年来在EGFR/ALK阳性NSCLC耐药机制及后续治疗策略相关研究中，有哪些关键突破性发现？
周彩存教授：在EGFR-TKIs和ALK-TKIs获得性耐药机制的研究方面，我们已取得一定进展。首先，我们需要通过活检获取肿瘤组织进行多组学分析，尝试找到个体化的耐药机制；同时，我们发现组织学转化是酪氨酸激酶抑制剂治疗后的关键耐药因素，因此应增加活检频次。
在获得性耐药后的治疗方面，我们也取得了一些突破。未来，我们将迎来第四代甚至第五代EGFR-TKIs，这些药物或能进一步提升治疗效果。在中国，已有多种新型药物获批用于酪氨酸激酶抑制剂治疗失败患者的二线或三线治疗，包括TROP2 抗体药物偶联物（ADCs）、双特异性抗体，且双抗ADC也即将获批。越来越多的新型药物正逐步应用于日常临床实践。
Paul Van Schil教授：我想补充的是，在欧洲，我们无法获取中国已获批的所有药物，治疗选择相当有限。此外，对于除EGFR或ALK突变外其他突变的患者，如何用高质量药物对其进行有效治疗，仍是一个亟待解决的挑战。
Professor Zhou: We have made some progress in understanding acquired resistance to EGFR-TKIs and ALK inhibitors. First, we need to perform a biopsy to obtain tissue for multi-omics analysis, trying to find private systems.We also discovered histological transformation, which is a key factor after TKI therapy. So we should perform more biopsies.After acquired resistance, we made some progress in the treatment we have. So in the near future, we will have fourth- and even fifth-generation EGFR-TKIs, these compounds may further improve efficacy. In China, several novel agents have been approved for second- or third-line treatment of TKI treatment failed patients: we have TROP2 ADCs, bispecific antibodies, and we will soon have bispecific ADCs. Many new compounds are entering our daily clinical practice.
Professor Paul Van Schil: I just want to say that in Europe, we don't have access to all the medications available in China，our options are quite limited. I think the problem is also the patients with additional mutations, besides EGFR or ALK,how to treat these patients effectively with high-quality medications. This remains a challenge.
肿瘤瞭望：从临床实践与研究视角，谈谈对比既往分期系统，胸腺肿瘤第九版TNM分期的核心临床优势是什么？未来需通过哪些研究方向，进一步实现 “精准分期向更优临床预后转化”的核心目标？
Paul Van Schil教授：遗憾的是，过去关于胸腺上皮肿瘤的研究仅有回顾性数据，缺乏采用电子数据采集（EDC）系统进行前瞻性数据收集的病例。为完善下一版分期，我们正努力改进这一现状：我们与欧洲胸外科医师学会（ESTS）合作建立了新的胸腺肿瘤数据库，增设了更多数据收集字段，这些数据将前瞻性地提交至IASLC，这是我们目前的工作重点。
关于第九版分期的变化主要调整并不多，包括如下几方面：T1期肿瘤现细分为T1a 期（≤5cm）和T1b期（>5cm），但两者仍同属I期。此前T1期胸腺肿瘤并无大小划分标准，这是本次分期的一大调整。
对于T2期肿瘤，以往T2期仅包括部分或完全心包侵犯，而我们发现，肺或膈神经直接受侵患者的预后优于其他特征T3期患者，因此这类病例现被归入T2 期。也就是说，T2期现在还包括心包、膈神经或肺组织受侵的情况。
未来，我们希望通过与欧洲、亚洲（包括中国和日本）的全球合作，我们将共同收集更多胸腺肿瘤前瞻性数据，进一步完善TNM分期和临床分期系统。
周彩存教授：这一进展非常好。Paul Van Schil教授在胸腺肿瘤和肺癌分期研究中发挥了重要作用。我们曾讨论过在肺癌TNM分期中纳入生物标志物，但不确定这一思路是否适用于胸腺肿瘤，目前尚无经过验证的胸腺肿瘤分期相关生物标志物。
Professor Paul Van Schil: For thymic epithelial tumors, unfortunately, we only had retrospective data in the past—there were not many cases with electronic data capture (EDC), which involves prospectively entered data. We are trying to improve this for the next edition: we have established a new thymic tumor database in collaboration with the European Society of Thoracic Surgeons (ESTS), with additional fields to collect more data. These data are prospectively submitted to IASLC—that's our current focus.
Regarding changes in the 9th edition: there were not many major changes. T1 tumors are now subdivided into T1a (≤5 cm) and T1b (>5 cm), but both still belong to stage I. Previously, there was no size criterion for T1 thymic tumors, but this has now been changed. For T2 tumors: previously, T2 only included partial or total pericardial invasion, but we now have seen that patients with direct invasion of the lung or phrenic nerve have a better prognosis than those with other T3-like features. So these cases are now included in T2. So T2 also includes involvement of the pericardium, phrenic nerve, or lung tissue itself.For the future, we hope to collect more data since these are rare tumors, but through global collaboration with Europe, Asia (including China and Japan), we can work closely to gather more prospective data on thymic tumors and refine the TNM and stage classifications.
Professor Zhou: That's great. Professor Paul played an important role in thymic tumor and lung cancer staging. We have discussed adding biomarkers to lung cancer TNM staging, but I'm not sure if this applies to thymic tumors. So far, we don't have any validated biomarkers for thymic tumor staging.
肿瘤瞭望：周教授，请您结合“QLC5508 治疗经治小细胞肺癌（SCLC）患者的安全性与疗效Ⅰ期研究”结果，分享下QLC5508治疗经治SCLC患者的临床疗效如何？其核心优势体现在哪些方面？
周彩存教授：在中国，已有多种抗体药物偶联物（ADCs），包括双特异性抗体ADC等。其中部分药物已获批用于EGFR突变NSCLC治疗，更多药物也即将获批，这类药物前景十分广阔。
在2025年世界肺癌大会（WCLC）上，我汇报了一款由中国企业自主研发B7-H3 ADC的研究数据。该药物耐受性良好，在广泛期小细胞肺癌（ES-SCLC）后线治疗中的肿瘤缓解率约为40%，疗效相当可观。目前我们正在中国开展相关II期临床试验。
在另一项研究中，我们评估了一款DLL3 ADC的疗效，在二线治疗中的肿瘤缓解率超过70%，这一结果令人惊叹。未来，我们将拥有更多抗体药物偶联物，这类药物或将很快改变我们的日常临床实践。
Professor Zhou: In China, we have many ADC compounds, including bispecific ADCs. Some of them have just been approved for treating EGFR-mutant lung cancer, and more will be approved soon. ADCs are very promising. At 2025 WCLC, I presented data on a B7-H3 ADC (a domestic compound developed by Chinese industry) at WCLC. This compound is well-tolerated and achieves an approximately 40% tumor response rate in later-line treatment of extensive-stage small cell lung cancer (ES-SCLC)—the efficacy is quite good. We are currently conducting an ongoing phase II trial in China. In another study, we evaluated a DLL3 ADC (another domestic compound)—it is even more efficacious, achieving a tumor response rate of over 70% in the second line, which is incredible. We will have more and more ADCs in the future, and these agents may change our daily clinical practice soon.
肿瘤瞭望：您以临床实践为出发点，谈谈您认为未来大数据和人工智能将如何改变肺癌的临床实践？如何将其与临床医生的经验更好地结合，为患者带来更多获益？
Paul Van Schil教授：人工智能已进入医疗领域并得到广泛应用，但我们需保持谨慎。当然，人工智能在放射科、病理科和肺癌筛查领域的价值毋庸置疑。例如，在肺癌筛查项目中，人工智能可协助筛选出无异常的正常病例，让放射科医生能将更多精力集中在疑难病例或疑似肺癌的临界病例上。病理科领域也是如此，人工智能在大量数据分析中能提供很大帮助。
在国际肺癌研究协会（IASLC）分期委员会工作中，人工智能在数据分析方面可发挥一定作用，但仍存在一定的壁垒，如若输入数据质量不佳，人工智能无法进行修正，它只能基于所提供的数据工作。由此可见，有时我们会高估人工智能的能力。当然，对于研究人员来说，人工智能的辅助作用已得到充分证实。
至于我的专业领域——胸外科，我认为人工智能不会取代外科医生。它能为我们提供帮助，但无法替代我们的工作。不过，我在中国参加多学科团队（MDT）会议时曾遇到一件令人惊讶的事：他们向我咨询一个疑难病例，患者转移性病变得到控制，但右肺中叶存在一个大肿瘤。他们问我：“您会建议手术切除吗？”我回答：“通常情况下不建议手术，因为患者存在多处转移，不应进行手术。”他们说：“但患者希望接受手术，不过我们会咨询人工智能的意见。”
随后他们将患者数据输入已验证的数据库，幸运的是，人工智能给出的结论是：“不建议切除肺叶”，即不建议进行肺叶切除术或双肺叶切除术。由此可见，人工智能确实能为临床决策提供帮助。
周彩存教授：我完全同意Paul Van Schil教授的观点。没有高质量数据，人工智能就无法发挥作用；但合理使用时，人工智能能为临床实践提供很大帮助，如今医院中人工智能的应用已十分普遍。
此外，在开展转化研究时，我们离不开人工智能，因为人类大脑无法高效分析海量数据。人工智能能处理数据分析工作，尤其是在多组学研究中，它能带来显著变革。目前，人工智能在放射科、病理科和肺癌筛查中的应用最为广泛。
Professor Paul Van Schil: AI has been introduced into healthcare and is now everywhere—we need to be careful. However, AI is certainly valuable in radiology, pathology, and screening. For example, in lung cancer screening programs, AI can can restart with the screening program. They can review images to identify normal cases (with no abnormalities), allowing radiologists to focus more on difficult or borderline cases (suspicious for cancer). The same applies to pathology: AI is very helpful for analyzing large amounts of data. For the IASLC Staging Committee, AI will certainly be useful for data analysis. But the problem is that if the input data is poor, AI cannot correct it, AI can only work with the data provided. Sometimes we overestimate AI's capabilities, but that's not realistic. And of course for researchers, it's very well established that AI can help. Regarding my own specialty—thoracic surgery—I don't think AI will take over. It can help us, but it will not replace us. I was surprised when I was in China at an MDT (Multidisciplinary Team) meeting: they asked me about a difficult case. The patient with controlled metastatic disease but a large tumor in the right middle lobe. They said, "Would you resect it?" I replied, "Normally, we should not do it, because there are several metastases—so we would not perform the surgery." They said, "But the patient wants to do it. However, we will consult AI." They input the patient's data into their validated database, and fortunately, the AI answer came back: "Do not resect the lobe." So do not perform a lobectomy or bilobectomy. Yeah,AI can help with clinical decisions.
Professor Zhou: I totally agree with Professor Paul. Without high-quality data, AI cannot work well. But when used properly, AI helps us a lot in clinical practice—AI is everywhere in hospitals now. When we conduct translational research (especially inclusive research), we need AI, because human brains cannot analyze huge datasets efficiently. AI can handle data analysis, especially for multi-omics research—it can bring significant changes. Currently, AI is most commonly used in radiology, pathology, and lung cancer screening.
But we should remain careful and critical. Even when you search on Google, AI is used for search algorithms now—but we must not blindly trust AI results. Thank you.
肿瘤瞭望：作为IASLC卸任主席，Prof. Paul Van Schil教授，想请您分享下您在任期内推动IASLC在肺癌领域的核心工作进展是什么？对 IASLC未来发展有哪些期待？
Paul Van Schil教授：在过去两年中，我最引以为傲的成就是推动完成了第九版 TNM分期这项极具挑战性的工作，相关论文已发表在《胸部肿瘤学杂志》（JTO）上。目前，我们正在为第十版分期做准备，这项工作将由周教授负责。我们还将所有统计工作迁移至Palmetto平台，希望能确保第十版分期顺利过渡，并在分期中更多融入组织学和生物标志物等因素。
在国际协作方面，我们成功举办了Pan-Africa大会，并计划每两年举办一次，以更好地覆盖非洲及其他中低收入国家（与我们在亚洲的工作模式类似）。此外，我们开展了更多多学科项目，并增设了专注于特定领域的委员会，例如临床科学委员会、基础科学委员会、筛查委员会等，同时还有多个专项工作组正在推进相关工作。
最后，我们也在努力提升协会期刊《胸部肿瘤学杂志》（JTO）和《胸部肿瘤学杂志 - 临床与研究报告》（JTO CRR）的质量，以维持其高影响因子，尤其是JTO杂志，我们致力于使其保持在该领域的顶尖水平。
Professor Paul Van Schil: Over the past two years, I am particularly proud of the 9th edition TNM classification—it was a challenging task, but we successfully completed it, and the papers were published in the Journal of Thoracic Oncology (JTO). Now, we are preparing for the 10th edition,this will be the job of Professor Zhou. We have also migrated all statistical work to Palmetto, hoping to ensure a smooth transition to the 10th edition with more integration of histology and biomarkers and so on. Regarding our worldwiderepresentation: we held the Pan-Africa Conference, which was a success, and we plan to repeat it every two years to better reach Africa and other LMICs (similar to our efforts in Asia). We now have more multidisciplinary projects and additional committees focused on specific aspects. With the specific purpose, we have Clinical Science Committee, Basic Science Committee, Screening Committee, and many task forcesgoing on.Lastly, we also try to strengthen our journals—JTO and JTO Clinical and Research Reports (JTO CRR)—to maintain their high impact factors, especially for JTO, which we aim to keep at the top of the field.
肿瘤瞭望：周教授，恭喜您接任IASLC主席，未来您在延续IASLC核心使命的基础上，有哪些重点工作规划？
周彩存教授：能在Paul Van Schil教授之后接任主席一职，我感到非常荣幸。过去两年，他担任主席期间表现出色，为协会树立了很高的标准，也让国际肺癌研究协会在全球的影响力和认可度进一步提升。在董事会成员和工作人员的支持下，我相信我们会努力做得更好。
Paul Van Schil教授：我也期待未来能与中国同仁开展更积极的合作，尤其是在肺癌患者诊疗领域，中国拥有很多大型癌症中心，在药物研发和临床研究方面也取得了出色成果。
Professor Zhou: I feel very lucky to take over after Paul, who has been an excellent president over the past two years. He set a very high bar and made IASLC even more influential and respected globally. With the support of our board members and staff, I believe we will strive to do even better.
Professor Paul Van Schil: I look forward to further active cooperation and collaboration, especially with Chinese colleagues.Especially for patient care—China has large cancer centers and is doing amazing work in drug development and clinical research.
专家简介
周彩存 教授
同济大学附属东方医院主任医师、教授、博士生导师
同济大学附属东方医院肿瘤科主任
同济大学医学院肿瘤研究所所长
国际肺癌研究协会（IASLC）主席中国医促会胸部肿瘤学分会 主任委员中国抗癌协会非小细胞肺癌专委会 主任委员上海市抗癌协会肺癌分子靶向和免疫治疗专委会 主任委员中国医师协会肿瘤分会 常委上海市抗癌协会 副理事长上海市医师协会肿瘤分会 副会长上海市医学会肿瘤分会 副主任委员
Paul Van Schil 教授
安普卫特大学医学院胸心血管外科教授
安特卫普外科培训和研究中心(ASTARC)成员
安特卫普大学医院胸心血管外科顾问
国际肺癌研究协会(IASLC)前任主席《胸肿瘤杂志》（Journal of Thoracic Oncology）、《肺病学》（Pulmonology）及《比利时外科学报》（Acta Chirurgica Belgica）的副主编主要研究方向：胸血管外科，重点研究领域包括肺癌分期与治疗、肺转移瘤、胸腺瘤及间皮瘤
来源：肿瘤瞭望
