鑲濇瘝绱�(x矛)鑳炵槫(hepatoblastoma,HB)鏄厭绔ユ湡鏈€甯歌鐨勮倽鑷熻叓鐦�锛�90%鐧�(f膩)鐢熶簬5姝蹭互鍏�(n猫i)銆傝┎鐥呰捣鐥呴毐鍖�锛屾棭鏈熷鐒＄櫏鐙€锛岀磩20%鐨勬偅鍏掑湪瑷烘柗鏅傚凡鐧�(f膩)鐢熼仩(yu菐n)铏曡綁(zhu菐n)绉�銆�

鎵嬭(sh霉)鍒囬櫎鑵槫鏄疕B鐨勯噸瑕佹不鐧傛墜娈�锛岃兘鍚﹀畬鏁村垏闄よ叓鐦ゆ槸褰遍熆闋�(y霉)鍚庣殑闂�(gu膩n)閸靛洜绱�锛屼絾鑻ヨê鏂锋槑纰哄悗鐩存帴鎵嬭(sh霉)锛岃叓鐦ゅ畬鍏ㄥ垏闄ょ殑姣斾緥鍍呯偤50%锝�60%锛屼笖鍠磾鎵嬭(sh霉)娌荤檪鐨勬偅鍏掑鏄撹(sh霉)鍚庡京(f霉)鐧�(f膩)銆傛墜琛�(sh霉)鍖栫檪灏嶄簬鎻愰珮澶栫鎵嬭(sh霉)鐨勮叓鐦ゅ畬鏁村垏闄ょ巼鍙婇檷浣庤叓鐦ゅ京(f霉)鐧�(f膩)鐜�

璧峰埌浜嗛噸瑕佷綔鐢�锛岃(sh霉)鍚庡寲鐧傚墖鍙€�(j矛n)涓€姝ユ秷闄ゅ師浣嶆畼鐣欏強閬�(yu菐n)铏曡綁(zhu菐n)绉荤梾鐏�銆傜洰鍓嶄互鎵嬭(sh霉)鑱�(li谩n)鍚堝寲鐧傜偤涓荤殑澶氬(xu茅)绉戣ê娌绘垚鐐篐B娌荤檪鐨勬(bi膩o)婧�(zh菙n)妯″紡銆�

浜屻€侀仼鐢ㄨ寖鍦�

灏忎簬18姝�銆佺稉(j墨ng)鍒囬櫎鎴栨椿妾㈢嵅寰楃梾鐞嗙祫绻旀(bi膩o)鏈€岀⒑瑷虹殑鏂扮櫦(f膩)鎮ｅ厭;灏忎簬5姝�銆佷即鏈夎吂閮ㄥ寘濉娿€佸瓨鍦ㄥ吀鍨嬬殑鑲濇瘝绱�(x矛)鑳炵槫褰卞儚瀛�(xu茅)琛ㄧ従(xi脿n)鍙婅娓呯敳鑳庤泲鐧界暟甯稿崌楂樻偅鍏�銆�

涓�銆佽ê鏂�

(涓€)鑷ㄥ簥琛ㄧ従(xi脿n)

澶氫互涓嶈(gu墨)鍓囧眬闄愭€ц倽鑷熻叓澶х偤鏈€鍒濈櫏鐙€锛岃叓濉婁綅浜庡彸鑵规垨鍙充笂鑵归儴銆傝叓鐦ょ敓闀疯繀閫�锛屾湁鐨勫彲閬�(d谩)鑷嶄笅鎴栬秴瓒婁腑绶�锛岃〃闈㈠厜婊�锛岄倞绶ｆ竻妤�锛岀‖搴︿腑绛夛紝鐣ヨ兘宸﹀彸绉诲嫊锛岀劇澹撶棝銆傝捣鐥呴毐鍖裤€�

鏃╂湡闄ゆ湁杓曞害璨ц澶�锛屼竴鑸儏娉佸鑹ソ銆傛櫄鏈熷墖鍑虹従(xi脿n)榛冪柛銆佽吂姘�銆佺櫦(f膩)鐔�銆佽钵琛€銆侀珨閲嶄笅闄�锛岃吂澹佸彲瑕嬮潨鑴堟€掑嫉锛屽苟鍙洜鑵瑰収(n猫i)宸ㄥぇ鑵閫犳垚鍛煎惛鍥伴洠銆�

(浜�)瀵﹂瀹ゆ鏌�

1.鐢茶儙铔嬬櫧:鐢茶儙铔嬬櫧(alphafetoprotein锛孉FP)姘村钩鍗囬珮鐐篐B閲嶈鐨勮ê鏂锋(bi膩o)婧�(zh菙n)涔嬩竴锛屽ぇ澶氭暩(sh霉)HB鐥呬汉AFP姘村钩鐣板父鍗囬珮锛孒B鐥呬汉鐨勮嚚搴婄梾鎯呰垏AFP姘村钩瀵嗗垏鐩搁棞(gu膩n)(涓嶅悓骞撮健绲勫厭绔ヨ娓匒FP姘村钩瑕嬭〃1)銆�

2.鍏朵粬瀵﹂瀹ゆ鏌�:琛€甯歌(gu墨);琛€鐢熷寲妾㈡煡锛氳倽鍔熻兘(璋蜂笝杞�(zhu菐n)姘ㄩ叾銆佺洿鎺ヨ喗绱呯礌)鍙婅几琛€鍓嶅偝鏌撶梾绡╂煡锛氫箼鑲�銆佷笝鑲濇姉楂斻€佹姣�銆佽壘婊嬬梾姣掓鏌�;鑵庡姛鑳�(灏跨礌姘�銆佽倢閰�銆佸翱閰�);闆昏В璩�(zh矛)鍙婅娣€绮夐叾娓畾;涔抽吀鑴矮閰�;鍑濊鍔熻兘;灏垮父瑕�(gu墨)鍜岀碁甯歌(gu墨)銆�

3.褰卞儚瀛�(xu茅)妾㈡煡锛氳兏閮–T銆佽吂閮ㄨ秴鑱�銆佽吂閮ㄥ寮�(qi谩ng)CT銆侀牠椤盡RI鍜岄鎺冩弿(蹇呰鏅�)銆�

4.鍏朵粬妾㈡煡锛氬績闆诲湒銆佽秴鑱插績鍕曞湒銆佸績鑲岄叾娓畾绛夊績鑷熷姛鑳芥鏌�;楠ㄩ珦绱�(x矛)鑳炲(xu茅)妾㈡煡(蹇呰鏅�)銆�

(涓�)鑷ㄥ簥瑷烘柗妯�(bi膩o)婧�(zh菙n)

1.灏忎簬5姝插厭绔ヤ即鏈夎吂閮ㄥ寘濉�锛屽瓨鍦ㄥ吀鍨婬B褰卞儚瀛�(xu茅)琛ㄧ従(xi脿n)鍙婅娓呯敳鑳庤泲鐧界暟甯稿崌楂�銆�

2.鍏稿瀷鐨勫奖鍍忓(xu茅)琛ㄧ従(xi脿n)锛氳吂閮–T鎻愮ず鑲濆収(n猫i)鍠櫦(f膩)鎴栧鐧�(f膩)鐨勫鎬х偤涓荤殑杌熺祫绻斿寘濉婏紝琛€渚涜睈瀵岋紝鍙镜鐘噸瑕佽绠�锛屽彲瑕嬮垼鍖栫伓鍙婂泭鎬у姝汇€傝吂閮ㄨ秴鑱查’绀哄柈鐧�(f膩)瀵﹁唱(zh矛)鎬у寘濉�锛屽皯鏁�(sh霉)鐥呬緥鍙偤澶氱櫦(f膩)鐥呯伓锛岀梾鐏堕倞绶ｆ竻鏅帮紝鍥炶伈杓曞害澧炲挤(qi谩ng)銆�

(鍥�)鐥呯悊妾㈡煡

1.鍏嶇柅绲勭箶鍖栧(xu茅)妾㈡脯

(1)鐢茶儙铔嬬櫧(AFP)銆佺７鑴傞叞鑲岄唶铔嬬櫧澶氱硸3(glypican⁃3)銆�β-閫ｆ帴铔嬬櫧(β⁃catenin)銆佽胺姘ㄩ叞鑳哄悎鎴愰叾(GS)銆佹尝褰㈣泲鐧�(vimentin)銆佽倽绱�(x矛)鑳炴姉鍘�(hepatocytic antigen)銆両NI1(鏁村悎閰剁浉浜掍綔鐢ㄥ洜瀛�);

(2)妾㈡脯CK7銆丆K19銆丆D34銆並i-67鏈夊姪浜庢彁绀鸿叓鐦ゆ槸鍚﹀悜鑶界绱�(x矛)鑳炲垎鍖�銆佹槑纰鸿倽琛€绔囦箣闁撹倽绱�(x矛)鑳炵储鐨勬暩(sh霉)鐩拰鑵槫绱�(x矛)鑳炵殑澧炴畺鎸囨暩(sh霉)銆�

2.绲勭箶瀛�(xu茅)鍒嗗瀷

(1)涓婄毊鍨嬶細

鈶犺儙鍏掑瀷:a.鍠磾鑳庡厭鍨嬩即鏍稿垎瑁傛椿鎬т綆锛�(<2/10楂樺€嶈閲�));b.鑳庡厭鍨�锛岄珮鏍稿垎瑁傛椿鎬э紝(≥2/10楂樺€嶈閲�));c.澶氬舰鎬ц儙鍏掑瀷(鍒嗗寲宸瀷);d.闁撹畩鎬ц儙鍏掑瀷(鏍告槑椤澶�銆佹繁鏌�銆佷即澶氬舰鎬�)銆�

鈶¤儦鑳庡瀷;

鈶㈠皬绱�(x矛)鑳炴湭鍒嗗寲鍨�(smallcellundifferentiated锛孲CU):a.INl-l闄芥€�;b.INl-l闄版€�銆�

鈶ｅ法灏忔鍨�;

鈶よ喗绠℃瘝绱�(x矛)鑳炲瀷銆�

(2)涓婄毊鑸囬枔钁夋贩鍚堝瀷锛�

鈶犱即鐣歌儙妯ｇ壒寰佺殑娣峰悎鍨�

鈶￠枔璩�(zh矛)渚嗘簮(涓嶄即鐣歌儙妯ｇ壒寰�)鐨勬贩鍚堝瀷

娉細鈶犲鏋滆叓鐦ょ祫绻斾腑鍚湁闁撹畩鎬х殑鎴愬垎锛屽缓璀版弿杩板苟鍒楀嚭鐧惧垎姣�;鈶″鐐虹┛鍒烘椿妾�锛屽缓璀拌嚦灏戦€佹5姊濈┛鍒虹祫绻�锛屾瘡姊濅笉灏戜簬1.0cm×0.3cm锛屼互浠ｈ〃鑵槫鐨勪笉鍚屽崁(q奴)鍩�锛屽苟鍖呭惈浠ｈ〃姝ｅ父绲勭箶鍜岃叓鐦ょ祫绻斾氦鐣岃檿鐨勭梾璁婄祫绻�銆傜嵅寰楃殑娲荤窗(x矛)鑳炴垚鍒嗗彲渚涚窗(x矛)鑳為伜鍌冲(xu茅)鍒嗘瀽銆�

(浜�)閼掑垾瑷烘柗

1.鑲濈窗(x矛)鑳炵檶:鐥呯悊涓奌B鑸囪倽绱�(x矛)鑳炵檶绱�(x矛)鑳炰箣闁撳樊鍒ヨ純澶�锛屽彲鍦ㄦ槸鍚﹀瓨鍦ㄦ槑鏆楃浉闁撶祼(ji茅)妲�(g貌u)銆佺窗(x矛)鑳炲ぇ灏忓舰鎱�(t脿i)鍙婃湁鐒￠珦澶栭€犺绛夋柟闈㈤櫎澶�;鑷ㄥ簥涓婅倽绱�(x矛)鑳炵檶鎮ｈ€呭鐐哄ぇ骞撮健鍏掔锛屾偅鍏掓垨鍏舵瘝瑕鏈変箼鍨嬭倽鐐庣梾姣掓劅鏌撶梾鍙�锛岃鐢熷寲琛ㄧ従(xi脿n)鐐鸿倽鍔熻兘鐣板父鍙婅喗绱呯礌鍗囬珮;褰卞儚瀛�(xu茅)妾㈡煡鍙鑲濈‖鍖栬〃鐝�(xi脿n)銆�

2.鑲濊嚐鐣歌儙鐦�:鑲濊嚐鍘熺櫦(f膩)鐣歌儙鐦ゅ彲鑸嘓B鏈夌浉浼肩殑鑷ㄥ簥琛ㄧ従(xi脿n)鍙夾FP鐨勫崌楂橈紝浣嗗奖鍍忓(xu茅)妾㈡煡鍙鑴傝偑鍙婇垼鍖栬〃鐝�(xi脿n)锛岀梾鐞嗘鏌ュ彲瑕嬭嚦灏�2鍊嬫垨浠ヤ笂鑳氬堡绲勭箶鎴栫祼(ji茅)妲�(g貌u)锛屽憟鐝�(xi脿n)鍚戜笉鍚岃儦灞ゅ垎鍖栫殑琛ㄧ従(xi脿n)锛屼絾鐣歌儙鐦や竴鑸矑鏈夎儙鍏掑瀷鎴栬儦鑳庡瀷HB鍗€(q奴)鍩熴€�

3.鍏朵粬鍏掔鎯℃€ц叓鐦よ倽鑷熻綁(zhu菐n)绉�:绁炵稉(j墨ng)姣嶇窗(x矛)鑳炵槫銆佹穻宸寸槫銆佹┇绱嬭倢鑲夌槫鍜屼績绲�(ji茅)绶犵祫绻斿鐢熸€у皬鍦撶窗(x矛)鑳炶叓鐦ょ瓑锛屽湪鐛插緱鐥呯悊绌垮埡妯�(bi膩o)鏈檪鍙€氶亷鐥呯悊妾㈡煡鏄庣⒑瑷烘柗锛屾澶栬娓呰叓鐦ゆ(bi膩o)瑷樼墿銆侀楂撶窗(x矛)鑳炲(xu茅)妾㈡煡鍙婂奖鍍忓(xu茅)妾㈡煡鍙崝(xi茅)鍔╄ê鏂�銆�

4.鍏朵粬鑲濊叓澶х殑鍘熷洜:濡備唬璎濇€х柧鐥呫€佽壇鎬ц倽鑵槫濡傝倽娴风犊鐙€琛€绠＄槫绛�銆�

鍥�銆佽嚚搴婂垎鏈熺郴绲�(t菕ng)鍙婂嵄闅害鍒嗙祫

(涓€)鑷ㄥ簥鍒嗘湡

1.PRETEXT(娌荤檪鍓�)鍒嗘湡鑸嘝OST-TEXT(鍖栫檪鍚庢墜琛�(sh霉)鍓�)鍒嗘湡锛歅RETEXT(pretreatmentextentofdisease)鍍呮寚娌荤檪鍓嶈叓鐦ょ疮鍙婅倽鑷熺殑鑼冨湇锛屼富瑕佺敤浜庤⿻浼板垵瑷烘墜琛�(sh霉)瀹屾暣鍒囬櫎鐨勫彲琛屾€�;POST-TEXT(post-treatmentextentof disease)鍓囨槸鎸囧寲鐧傚悗鑲濊嚐鑵鐨勭疮鍙婅寖鍦�锛屼富瑕佺敤浜庤⿻浼板欢鏈熸墜琛�(sh霉)瀹屾暣鍒囬櫎鐨勫彲琛屾€�銆�

鍚勬湡瀹氱京濡備笅锛�

鈶碢RETEXT/POST-TEXTI锛氳叓鐦ゅ眬闄愬湪1鍊嬭倽鍗€(q奴)锛岀浉閯扮殑鍙﹀3鍊嬭倽鍗€(q奴)鐒¤叓鐦や镜鐘�;

鈶礟RETEXT/POST-TEXT鈪★細鑵槫绱強1鍊嬫垨2鍊嬭倽鍗€(q奴)锛岀浉閯扮殑鍙﹀2鍊嬭倽鍗€(q奴)鐒¤叓鐦や镜鐘�;

鈶禤RETEXT/POST-TEXT鈪細2鍊嬫垨3鍊嬭倽鍗€(q奴)鍙楃疮锛屽彟1鍊嬬浉閯扮殑鑲濆崁(q奴)鏈彈绱�;

鈶稰RETEXT/POST-TEXT鈪ｏ細鑵槫绱強鎵€鏈�4鍊嬭倽鍗€(q奴)銆�

2.鏀硅壇鐨凜OGEvans鍒嗘湡绯荤当(t菕ng)

鈪燼鏈燂細鑵槫瀹屽叏鍒囬櫎锛岀祫绻旂梾鐞嗗(xu茅)椤炲瀷鐐哄柈绱旇儙鍏掑瀷;

鈪燽鏈燂細鑵槫瀹屽叏鍒囬櫎锛岄櫎鍠磾鑳庡厭鍨嬩互澶栧叾浠栫祫绻旂梾鐞嗗(xu茅)椤炲瀷;

鈪℃湡锛氳叓鐦ゅ熀鏈垏闄�锛屾湁閺′笅娈樼暀;

鈪㈡湡锛氳叓濉婃湁鑲夌溂娈樼暀;鎴栧熀鏈垏闄や即娣嬪反绲�(ji茅)闄芥€�;鎴栬叓鐦ょ牬瑁傛垨鑵硅啘鍏�(n猫i)鍑鸿;

鈪ｆ湡锛氳ê鏂锋檪鐧�(f膩)鐢熼仩(yu菐n)铏曡綁(zhu菐n)绉伙紝涓嶈珫鍘熺櫦(f膩)鐥呯伓鏄惁瀹屽叏鍒囬櫎銆�

(浜�)鑷ㄥ簥鍗遍毆搴﹀垎绲�

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1.妤典綆鍗辩祫锛氳(sh霉)鍚嶤OG鍒嗘湡鐐衡厾鏈熶笖绲勭箶鐥呯悊瀛�(xu茅)椤炲瀷鐐哄垎鍖栬壇濂界殑鍠磾鑳庡厭鍨嬫偅鍏掋€�

2.浣庡嵄绲勶細绗﹀悎浠ヤ笅浠讳綍1闋呮垨澶氶爡銆傗憼琛€娓匒FP≥100ng/ml鐨凱RETEXTI鏈熸垨鈪℃湡锛屼笖闄ゅP+(渚电姱闁€闈滆剤)銆乂+(渚电姱涓嬭厰闈滆剤鎴栬€呰倽闈滆剤)銆丮+(閬�(yu菐n)铏曡綁(zhu菐n)绉�)銆丒+(鑲濆鑵瑰収(n猫i)鐤�

鐥�)銆丠+(鑵槫鐮磋鎴栬吂鑶滃収(n猫i)鍑鸿)銆丯+(渚电姱娣嬪反绲�(ji茅));鈶¤(sh霉)鍚嶤OG鍒嗘湡鐐篒鏈熸垨鈪℃湡锛屼笖绲勭箶鐥呯悊瀛�(xu茅)椤炲瀷鐐洪潪鍠磾鑳庡厭鍨嬪拰闈炲皬绱�(x矛)鑳炴湭鍒嗗寲鍨�銆�

3.涓嵄绲勶細绗﹀悎浠ヤ笅浠讳綍1闋呮垨澶氶爡銆傗憼琛�(sh霉)鍓峆RETEXT鈪㈡湡;鈶¤(sh霉)鍚嶤OG鍒嗘湡鐐篒鏈熸垨鈪℃湡锛屼笖绲勭箶鐥呯悊椤炲瀷鐐哄皬绱�(x矛)鑳炴湭鍒嗗寲鍨�;鈶㈣(sh霉)鍚嶤OG鍒嗘湡鐐衡參鏈�銆�

4.楂樺嵄绲勶細绗﹀悎浠ヤ笅妯�(bi膩o)婧�(zh菙n)浠讳綍涓€姊濆潎鐐洪珮鍗辩祫銆傗憼琛€娓匒FP<100ng/ml;鈶¤(sh霉)鍓峆RETEXT鈪ｆ湡;鈶㈣(sh霉)鍚嶤OG鍒嗘湡鐐衡叄鏈�;鈶+(渚电姱闁€闈滆剤)銆乂+(渚电姱涓嬭厰闈滆剤鎴栬€呰倽闈滆剤)銆�

浜斻€佹不鐧�

鐩墠鍦嬮殯涓婂厭绔B鐨勬不鐧傚師鍓囩浉浼�锛岃┎瑕�(gu墨)鑼冪殑娌荤檪鍘熷墖鍜岀窗(x矛)鍓囬噸榛炲弮鑰僀OG銆佹瓙娲插湅闅涘厭绔ヨ倽鑵槫鍗�(xi茅)浣滅祫鍜孋CCG-HB鏂规锛屾彁渚涚殑浠ヤ笅娌荤檪鏂规鍚勯啱(y墨)闄㈡牴鎿�(j霉)鍚勮嚜鎯呮硜閬告搰鎳�(y墨ng)鐢�銆傞儴鍒嗙梾浜哄彲绲�(ji茅)鍚堟墍鍦ㄩ啱(y墨)闄㈠闅涙儏娉侀仼鐣�(d膩ng)鏀硅壇銆�

鐗规畩娌荤檪鎺柦鐨勯伕鎿囦互鍙婇仼鎳�(y墨ng)璀夊缓璀板弮鑰冦€婂厭绔ヨ倽姣嶇窗(x矛)鑳炵槫澶氬(xu茅)绉戣ê鐧傝€佸斧鍏辫瓨CCCG-HB-2016銆嬨€愪腑鑿皬鍏掑绉戦洔蹇�2017骞寸38鍗风10鏈熴€戠殑鐩搁棞(gu膩n)绱�(x矛)鍓�銆�

(涓€)鎵嬭(sh霉)娌荤檪

1.鍒濊ê鎵嬭(sh霉)鍒囬櫎鎸囧緛锛�

(1)缇庡湅楹婚唹甯崝(xi茅)鏈冭⿻鍒�1锝�2绱�;

(2)缍�(j墨ng)褰卞儚瀛�(xu茅)瑭曚及锛屾畼瀛樿倽鑷熺祫绻斿ぇ浜庡師楂旂⿳鐨�35%锛屽姛鑳借兘澶犳豢瓒充唬璎濋渶瑕�;

(3)PRETEXTI銆佲叀鏈熺殑鍠櫦(f膩)鑵槫鐥呯伓锛岃窛闆㈤噸瑕佽绠℃湁瓒冲闁撻殭(≥1cm);

(4)闋�(y霉)瑷堥彙涓嬫畼鐣�(COG鈪℃湡)鐒￠渶浜屾鎵嬭(sh霉)鑰�銆�

2.寤舵湡鎵嬭(sh霉)鎸囧緛锛�

(1)PRETEXT鈪㈡湡銆佲叄鏈熸偅鍏�锛屽湪娲绘鏄庣⒑瑷烘柗鍏堣鏂拌紨鍔╁寲鐧傚悗锛屽啀琛屽欢鏈熸墜琛�(sh霉);

(2)鍖栫檪鍚庤⿻浼扮偤POST-TEXTI鏈�銆佲叀鏈燂紝鎴栨矑鏈夐噸瑕佽绠�(闁€闈滆剤鎴栦笅鑵旈潨鑴�)绱強鐨凱OST-TEXT鈪㈡湡鎮ｅ厭锛屽彲琛岃倽钁夊垏闄ゆ垨鍒嗘鍒囬櫎;

(3)灏峆RETEXT鈪ｆ湡鍜屽寲鐧傚悗瑭曚及鐐篜OST-TEXT鈪㈡湡骞朵即鏈変笅鑵旈潨鑴�(V+)鎴栭杸闈滆剤(P+)绱強鐨勬偅鍏�锛屾噳(y墨ng)瑭茬洝鏃╄綁(zhu菐n)鍏ュ叿鏈夊京(f霉)闆滆倽娈靛垏闄ゆ垨鑲濈Щ妞嶈兘鍔涚殑閱�(y墨)闄㈡不鐧�;

(4)鍖栫檪鍚庝粛娈樼暀鑲烘垨鑵﹀柈鐧�(f膩)杞�(zhu菐n)绉荤梾鐏惰€�锛屽彲琛屾畼鐣欑梾鐏舵墜琛�(sh霉)鍒囬櫎銆�

(浜�)鍖栫檪

1.妤典綆鍗辩祫鎮ｅ厭琛�(sh霉)鍚庝笉鍖栫檪锛屽瘑鍒囬毃瑷�銆�

2.浣庡嵄绲勫寲鐧傛柟妗堬細

C5V(闋嗛墤+5-姘熻劜鍢у暥+闀锋槬鏂板牽)锛氶爢閴�90mg/m²锛岄伩鍏夋寔绾�(x霉)闈滄淮≥6h锛岀1澶�;5-姘熻劜鍢у暥600mg/m²锛岄潨婊�4h锛岀2澶�;闀锋槬鏂板牽1.5mg/m²锛岄潨鎺�(鍠鏈€澶у姂閲�≤2mg)锛岀2澶┿€傛瘡21澶�1鍊嬪寲鐧傚懆鏈�锛岀附鐧傜▼鐐�4锝�6鍊嬪懆鏈熴€�

3.涓嵄绲勫寲鐧傛柟妗堬細

C5VD(闋嗛墤+5-姘熻劜鍢у暥+闀锋槬鏂板牽+闃块湁绱�)锛氶爢閴�90mg/m²锛岄伩鍏夋寔绾�(x霉)闈滆剤婊存敞≥6h锛岀1澶�;5-姘熻劜鍢у暥600mg/m²锛岄潨鑴堟淮娉�4h锛岀2澶�;闀锋槬鏂板牽1.5mg/m²锛岄潨鑴堝皠(鍠鏈€澶у姂閲�≤2mg)锛岀2澶�;闃块湁绱�25mg/m²锛岄潨鑴堟淮娉�6h锛岀2銆�3澶�銆傛瘡21澶�1鍊嬪寲鐧傚懆鏈�锛屽寲鐧�2锝�4鍊嬪懆鏈熷悗鎿囨湡鎵嬭(sh霉)锛岀附鐧傜▼鐐�6锝�8鍊嬪懆鏈�銆�

4.楂樺嵄绲勫寲鐧傛柟妗堬細

闋嗛墤+闃块湁绱狅細闋嗛墤80mg/m²锛岄伩鍏�銆佹寔绾�(x霉)闈滄淮≥6h锛岀1澶�;闃块湁绱�30mg/m²锛岄潨鑴堟淮娉�6h锛岀2銆�3澶�?锛熴劊K+闃块湁绱狅細鍗￠墤500mg/m²锛岄潨鑴堟淮娉�2h锛岀1澶�;闃块湁绱�20mg/m²锛岄潨鑴堟淮娉�6h锛岀1銆�2澶�銆傜暟鐠�(hu谩n)纾烽叞鑳�+鍗￠墤+渚濇墭娉婅嫹锛氱暟鐠�(hu谩n)纾烽叞鑳�1.5g/m²锛岄潨婊�2锝�3h锛岀1锝�5澶�;鍗￠墤450mg/m²锛岄潨鑴堟淮娉�2锝�4h锛岀1澶�;渚濇墭娉婅嫹100mg/m²锛岄潨鑴堟淮娉�2锝�4h锛岀1锝�3澶�銆傛瘡21澶�1鍊嬪寲鐧傚懆鏈�锛岄爢閴�+闃块湁绱犲寲鐧�3鍊嬪懆鏈熷悗瑭曚及锛屽彲琛屾墜琛�(sh霉)鍒囬櫎鑰�锛岃(sh霉)鍚庢噳(y墨ng)鐢ㄥ崱閴�+闃块湁绱犳柟妗堢辜绾�(x霉)鍖栫檪锛岀附鐧傜▼鐐�6锝�10鍊嬪懆鏈熴€傞爢閴�+闃块湁绱犳柟妗堝寲鐧�3鍊嬪懆鏈熷悗瑭曚及锛屾湭鑳芥墜琛�(sh霉)鍒囬櫎鑰咃紝鏀圭偤鐣扮挵(hu谩n)纾烽叞鑳�+鍗￠墤+渚濇墭娉婅嫹鏂规锛屽寲鐧�2鍊嬪懆鏈熷悗绻肩簩(x霉)瑭曚及鎵嬭(sh霉)锛岀附鐧傜▼鐐�8锝�10鍊嬪懆鏈熴€�

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3.涓€х矑绱�(x矛)鑳炵己涔忥細灏嶉爯(y霉)鏈熸渻鍑虹従(xi脿n)杓冮暦鏅傞枔绮掔窗(x矛)鑳炵己涔忚€呭彲浠ヤ娇鐢ㄧ矑绱�(x矛)鑳為泦钀藉埡婵€鍥犲瓙銆備互涓婂寲鐧傝棩鐗╂瘨鎬у垎绱氭(bi膩o)婧�(zh菙n)瑭宠闄勮〃2

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2.閮ㄥ垎绶╄В(PR)锛氳叓鐦ょ府灏�≥50%锛岀劇浠讳綍鏂扮櫦(f膩)鎴栫柧鐥呴€�(j矛n)灞曠殑璀夋摎(j霉)銆�

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5.寰�(f霉)鐧�(f膩)(Recurrence)锛氭椿妾㈣瓑瀵�;鏄庣⒑鐨勫奖鍍忓(xu茅)璀夋摎(j霉)涓旇娓匒FP4鍛ㄥ収(n猫i)閫ｇ簩(x霉)3娆″楂樸€�

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鑷熷櫒鍔熻兘鎼嶅锛氭噳(y墨ng)鐢ㄩ墤椤炶€呴€�(j矛n)琛岃伣鍔涙鏌ヨ嚦鍋滆棩鍚�2骞�;琛屽績闆诲湒妾㈡煡鍜屽績鑷熻秴鑱叉鏌ヨ嚦鍋滆棩鍚�2骞淬€�

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