Editor's Note: On April 23-24, the 2022 CSCO Guidelines Conference was held as scheduled in a hybrid online and offline format. Regardless of changes in the external environment, the Chinese Society of Clinical Oncology (CSCO) has never paused its efforts to advance the industry and improve the standardized diagnosis and treatment of tumors in China. This guideline meeting covered updates and insightful interpretations of guidelines for major tumor types. In addition, multiple guidelines were issued on tumor metastasis, adverse reactions to tumor treatment, and other aspects, providing a basis for clinical work and standardized diagnosis and treatment. CCMTV Oncology Channel specially invited CSCO President and Professor at Sun Yat-sen University Cancer Center, Xu Ruihua to introduce the implementation of the CSCO series guidelines and the advancement of the society's work.

Professor Xu Ruihua: As the topic suggests, the "14th Five-Year Plan" for clinical specialty capacity building has always emphasized strengthening the core clinical specialty capabilities and building a high-quality and efficient medical and health service system. The Chinese Society of Clinical Oncology (CSCO) has been implementing the development of tumor prevention and treatment in China. Multiple CSCO presidents and the council have promoted the writing, revision, and release of the CSCO series guidelines to advance standardized clinical oncology diagnosis and treatment in China.

After years of development, the CSCO series guidelines have become increasingly refined. When revising the guidelines, each specialized committee not only bases their work on international evidence-based medical evidence but also considers the diagnostic and treatment levels and drug accessibility in various regions of China. Therefore, the CSCO guidelines have unique advantages in practical standardized tumor diagnosis and treatment. Clinical specialists can use the guidelines to implement individualized treatment for different patients, making them highly practical. Moreover, the CSCO guidelines have excellent guiding value across hospitals of different levels.

In summary, through the strong promotion of the CSCO series guidelines by the Chinese Society of Clinical Oncology council over many years, the guidelines have played a crucial role in the standardized diagnosis and treatment of tumors in China. The audience, influence, and widespread application of the CSCO guidelines are unprecedented.

Professor Xu Ruihua: The Chinese Society of Clinical Oncology attaches great importance to tumor prevention, screening, and the implementation of tumor treatment strategies. It also focuses on implementing policies and guidance issued by the National Health Commission and other departments to promote tumor prevention and treatment and improve medical standards. Besides paying attention to popular science-related fields, CSCO has a continuing education department that annually conducts various forms of popular science publicity and education through the CSCO headquarters and professional committees, covering knowledge related to tumor prevention, screening, and treatment.

Currently, there is still a certain gap in the popularization of tumor prevention and screening and the acceptance level among the general public in China. Regarding treatment decision-making in clinical oncology, I believe CSCO plays a very important role. Many frontline clinical doctors can quickly understand the current international diagnosis and treatment status through the recommendations of the CSCO series guidelines and decide on patient treatment plans through clear and concise guidance, which to some extent avoids possible errors during treatment.

Therefore, I believe CSCO should continue to strengthen popular science publicity, screening, early diagnosis, and early treatment of tumors, further accelerate the widespread promotion and implementation of the CSCO series diagnosis and treatment guidelines, especially enabling primary hospitals to grasp the essential points of the guidelines while carrying out tumor treatment and management, so that patients can receive standardized comprehensive tumor treatment.

Professor Xu Ruihua: This is a very important but also very sensitive topic. As a first-level association, CSCO in its early development phase focused more on "bringing in," that is, introducing excellent diagnosis and treatment concepts, plans, and research experiences from developed countries and regions. After learning and absorbing these, we then innovate. In the past 15 to 20 years, we have mainly focused on digestion, absorption, and innovation, establishing concepts of standardized diagnosis and treatment, evidence-based medicine, and multidisciplinary treatment in clinical oncology.

With the continuous improvement of China's comprehensive national strength and the growth of original innovative pharmaceutical companies, we now have the capability to "go global." On one hand, this is reflected in diagnosis and treatment plans; for example, some diagnosis and treatment plans and innovative technologies for high-incidence tumors in China have been accepted and promoted worldwide. Our achievements in nasopharyngeal carcinoma, liver cancer, esophageal cancer, and gastric cancer have become important evidence in today's international guidelines.

When facing the difficulties of domestic innovative drugs "going global," I believe "going global" is an inevitable trend. However, several aspects need attention: First, domestic innovative drug companies need to focus on more truly original innovations; uniqueness will inevitably lead to international success. Second, innovative drug companies need greater courage, a longer-term vision, and higher-level planning. They should set international strategic goals early in drug development, including how to consider registration policies of different countries and regions in clinical research design, and how China's clinical research—including principal investigators, research units, and researchers—can explore the "going global" path with companies from an international perspective. This may alleviate some difficulties in "going global."

Of course, besides scientific issues, many other factors restrict "going global." But I believe that no matter what, we should first do our own work well, achieve scientific leadership, and ensure patients truly benefit. The difficulties of "going global" will gradually be resolved.

Professor Xu Ruihua: During the update process of the 2022 CSCO colorectal cancer diagnosis and treatment guidelines, the revision was a collective effort, involving important domestic experts and institutions as writing members. Overall, there were not many updates this year because colorectal cancer treatment has stabilized in recent years, and many new therapies have not made significant breakthroughs in colorectal cancer.

In brief, there are four main updates: First, in imaging diagnosis, chest plain CT scan has been included as a level I recommendation; second, in adjuvant therapy, for "low-risk stage II (T ₃ N ₀ M ₀ For patients with dMMR, regardless of the presence of high-risk factors, a 3-month CAPEOX adjuvant chemotherapy regimen can be considered; third, in the palliative treatment group for second- and third-line treatment regimens, immune checkpoint inhibitors (PD-1 and PD-L1 inhibitors) are recommended at level II for patients with MSI-H/dMMR who have not used immune checkpoint inhibitors in the first line; fourth, during follow-up, the importance of liquid biopsy ctDNA monitoring for early warning of postoperative recurrence and metastasis is emphasized.

Overall, the 2022 version of the CSCO colorectal cancer diagnosis and treatment guidelines has few updates, and the entire treatment framework remains basically stable.

Source of this article: CCMTV Oncology Channel

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