Currently there is no established guidance on how to process and evaluate resected lung cancer specimens following neoadjuvant therapy in the setting of clinical trials and clinical practice. There is also a lack of precise definitions on the degree of pathologic response, including major pathologic response (MPR) or complete pathologic response (CPR). In other cancers such as osteosarcoma, colorectal, breast and esophageal carcinomas, there have been multiple studies investigating pathologic assessment of the effects of neoadjuvant therapy including some detailed recommendations on how to handle these specimens. A comprehensive mapping approach to gross and histologic processing of osteosarcomas following induction therapy has been used for over 40 years. The purpose of this article is to outline detailed recommendations on how to process lung cancer resection specimens and to define pathologic response including MPR and CPR following neoadjuvant therapy. A standardized approach is recommended to assess the percentages of: 1) viable tumor, 2) necrosis and 3) stroma (including inflammation and fibrosis) with a total adding up to 100%. This is recommended for all systemic therapies including chemotherapy, chemoradiation, molecular targeted therapy, immunotherapy or any future novel therapies yet to be discovered whether administered alone or in combination. Specific issues may differ for certain therapies such as immunotherapy, but the grossing process should be similar and the histologic evaluation should contain these basic elements. Standard pathologic response assessment should allow for comparisons between different therapies and correlations with disease free survival and overall survival in ongoing and future trials. The International Association for the Study of Lung Cancer (IASLC) has an effort to collect such data from existing and future clinical trials. These recommendations are intended as guidance for clinical trials, although it is hoped they can be viewed as suggestion for good clinical practice outside of clinical trials, to improve consistency of pathologic assessment of treatment response.

中文翻译：

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IASLC 新辅助治疗后肺癌切除标本病理学评估的多学科建议

目前还没有关于在临床试验和临床实践中如何处理和评估新辅助治疗后切除的肺癌标本的既定指南。对于病理反应的程度，包括主要病理反应（MPR）或完全病理反应（CPR），也缺乏准确的定义。在骨肉瘤、结直肠癌、乳腺癌和食道癌等其他癌症中，已有多项研究对新辅助治疗效果的病理评估进行了调查，包括一些关于如何处理这些标本的详细建议。诱导治疗后骨肉瘤的大体和组织学处理的综合映射方法已经使用了 40 多年。本文的目的是概述有关如何处理肺癌切除标本和定义新辅助治疗后的病理反应（包括 MPR 和 CPR）的详细建议。建议采用标准化方法来评估以下百分比：1) 存活肿瘤，2) 坏死和 3) 基质（包括炎症和纤维化），总和为 100%。这被推荐用于所有全身疗法，包括化学疗法、放化疗、分子靶向疗法、免疫疗法或任何未来尚未发现的新疗法，无论是单独给药还是联合给药。某些疗法（例如免疫疗法）的具体问题可能有所不同，但总体过程应该相似，并且组织学评估应包含这些基本要素。标准病理反应评估应允许在正在进行和未来的试验中比较不同的治疗方法以及与无病生存期和总生存期的相关性。国际肺癌研究协会 (IASLC) 正在努力从现有和未来的临床试验中收集此类数据。这些建议旨在作为临床试验的指导，尽管希望它们可以被视为临床试验之外的良好临床实践的建议，以提高治疗反应病理评估的一致性。