血液肿瘤合并实体肿瘤诊疗专家共识（2025年版）

中国抗癌协会多原发和不明原发肿瘤专业委员会; 上海市抗癌协会多原发和不明原发肿瘤专业委员会; 中华医学会血液学分会淋巴细胞疾病学组; 中华医学会血液学分会罕见病学组

doi:10.19401/j.cnki.1007-3639.2025.10.010

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血液肿瘤合并实体肿瘤诊疗专家共识（2025年版）

指南与共识 | 更新时间：2025-12-31

- 血液肿瘤合并实体肿瘤诊疗专家共识（2025年版）
- Expert consensus on diagnosis and treatment of hematologic malignancies with solid tumors (2025 version)
- 中国癌症杂志 2025年35卷第10期页码：968-985
- 作者机构：
- 作者简介：
- 基金信息：
  
  国家自然科学基金(82573699)
- DOI：10.19401/j.cnki.1007-3639.2025.10.010
  中图分类号： R733
- 收稿：2025-07-25，
  
  修回：2025-10-20，
  
  纸质出版：2025-10-30
- 稿件说明：
移动端阅览
中国抗癌协会多原发和不明原发肿瘤专业委员会, 上海市抗癌协会多原发和不明原发肿瘤专业委员会, 中华医学会血液学分会淋巴细胞疾病学组, 等. 血液肿瘤合并实体肿瘤诊疗专家共识（2025年版）[J]. 中国癌症杂志, 2025,35(10):968-985.

Multiple Primary and Unknown Primary Tumors Special Committee of China Anti-Cancer Association, Shanghai Anti Cancer Association Multiple Primary and Unknown Primary Tumor Special Committee, Lymphocytic Disease Group, Hematology Branch, Chinese Medical Association, et al. Expert consensus on diagnosis and treatment of hematologic malignancies with solid tumors (2025 version)[J]. China Oncology, 2025, 35(10): 968-985.
中国抗癌协会多原发和不明原发肿瘤专业委员会, 上海市抗癌协会多原发和不明原发肿瘤专业委员会, 中华医学会血液学分会淋巴细胞疾病学组, 等. 血液肿瘤合并实体肿瘤诊疗专家共识（2025年版）[J]. 中国癌症杂志, 2025,35(10):968-985. DOI： 10.19401/j.cnki.1007-3639.2025.10.010.

Multiple Primary and Unknown Primary Tumors Special Committee of China Anti-Cancer Association, Shanghai Anti Cancer Association Multiple Primary and Unknown Primary Tumor Special Committee, Lymphocytic Disease Group, Hematology Branch, Chinese Medical Association, et al. Expert consensus on diagnosis and treatment of hematologic malignancies with solid tumors (2025 version)[J]. China Oncology, 2025, 35(10): 968-985. DOI： 10.19401/j.cnki.1007-3639.2025.10.010.

摘要

血液肿瘤合并实体肿瘤（hematologic malignancies with solid tumor，HM-ST）作为多原发肿瘤（multiple primary malignancies，MPM）的一种特殊类型，在临床实践中日益增多，给诊疗带来严峻挑战。两种肿瘤在生物学行为、治疗策略及患者的预后上差异巨大，治疗决策需综合考虑优先顺序、同步/序贯化疗方案的选择及毒性管理。由于高质量研究证据缺乏，临床实践中常依赖于医师有限的经验。本共识旨在结合国内外最新进展及中国临床实践经验，梳理HM-ST的定义、分类、流行病学、病理学机制[如潜能不明的克隆性造血（clonal hematopoiesis of indeterminate potential，CHIP）、RNA剪接异常]、诊断流程（强调病理学诊断、分子生物学诊断及影像学诊断技术如PET/CT与靶向探针的应用）、治疗原则[突出多学科诊疗团队（multidisciplinary team，MDT）协作、治疗优先级决策、毒性管理、精细化放疗及“异病同治”策略]和随访管理。本共识重点提出了诊断、评估、治疗及随访方面的系列化推荐意见，以期为临床医师提供一套规范化、操作性强的指导依据，优化HM-ST患者的个体化诊疗，改善患者的预后并提高患者的生活质量。本共识已在国际实践指南注册平台（Practice guideline REgistration for transPAREncy，PREPARE）注册，注册号为PREPARE-2025CN1599。

Abstract

Hematologic malignancies with solid tumors (HM-ST)

a special subtype of multiple primary malignancies (MPMs)

are increasingly encountered in clinical practice

posing significant diagnostic and therapeutic challenges. The two types of tumors exhibit vast differences in biological behavior

treatment strategies

and prognosis. Treatment decisions require comprehensive consideration of prioritization

synchronous/metachronous approaches

and toxicity management. Due to the scarcity of high-quality research data

clinical practice often relies on limited experience. This consensus aimed to integrate the latest international advancements with Chinese clinical practice experience to delineate the definition

classification

epidemiology

pathogenesis [e.g.

clonal hematopoiesis of indeterminate potential (CHIP)

RNA splicing abnormalities]

diagnostic workflow (emphasizing pathology

molecular diagnosis

and advanced imaging techniques such as PET/CT with targeted probes)

treatment principles [highlighting multidisciplinary team (MDT) collaboration

treatment prioritization

toxicity management

refined radiotherapy

and the strategy of “treating different diseases with the same method” ]

and follow-up management for HM-ST. This consensus specifically puts forward a series of recommendations regarding diagnosis

assessment

treatment

and follow-up

intending to provide clinicians with standardized and practical guidance

optimize individualized management for HM-ST patients

and ultimately improve their prognosis and quality of life. This consensus has been registered on the Practice guideline REgistration for transPAREncy (PREPARE) platform (registration number: PREPARE-2025CN1599).

关键词

Keywords

references

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