引用文本：陈瑞平, 曾博. 2026年中国临床肿瘤学会食管癌诊疗指南更新要点解读[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 364-368.

作者：陈瑞平，曾博

单位：中山大学附属第一医院 胸外科，广东 广州 510080

Authors：Chen Ruiping, Zeng Bo

Unit：Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

食管癌是我国常见消化道恶性肿瘤之一，且以食管鳞状细胞癌为主要病理类型，其疾病谱与欧美国家存在明显差异。中国临床肿瘤学会（Chinese Society of Clinical Oncology, CSCO）《食管癌诊疗指南（2026）》在2025版基础上，结合近年来国内外研究进展和中国临床实践需求，对食管癌诊疗路径进行了进一步优化。本文基于2025版与2026版CSCO食管癌诊疗指南的核心内容，对2026版更新要点进行系统梳理，并结合日本食管学会（Japan Esophageal Society, JES）、美国国立综合癌症网络（National Comprehensive Cancer Network, NCCN）及欧洲肿瘤内科学会（European Society for Medical Oncology, ESMO）相关指南进行比较分析。2026版CSCO指南的核心更新主要包括首次将食管鳞状细胞癌与腺癌治疗策略分开单列，强调不同病理类型的生物学差异及证据适配；进一步明确早期食管癌内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）术后处理原则，尤其突出T_1b期不同黏膜下浸润深度亚型的淋巴结转移风险分层；明确食管胃结合部腺癌围手术期FLOT方案（奥沙利铂+多西他赛+氟尿嘧啶+亚叶酸钙）联合免疫治疗的适用范围，提出应严格依据程序性死亡受体配体1（programmed death-ligand 1, PD-L1）表达、肿瘤区域阳性评分（tumor area positivity score, TAP）、术前淋巴结状态及病理分型筛选优势人群。与2025版相比，2026版CSCO指南更加突出组织学分型精准化、治疗决策分层化和多学科管理常态化。与国际指南比较，2026版CSCO指南更符合我国以鳞状细胞癌为主、区域发展不平衡和资源可及性差异显著的临床现实。本文认为，2026版CSCO指南更新不仅优化了食管癌规范化诊疗路径，也进一步推动我国食管癌管理由“同病同治”向“分型而治、精准施治”转变。

关键词：食管肿瘤；中国临床肿瘤学会；诊疗指南；鳞状细胞癌；腺癌；内镜黏膜下剥离术；免疫治疗

Abstract：

Esophageal cancer is one of the most common gastrointestinal malignancies in China, with esophageal squamous cell carcinoma being the predominant histological subtype, which differs substantially from the disease spectrum in European and American countries. Based on recent advances in evidence-based medicine and the practical needs of Chinese clinical settings, the Chinese Society of Clinical Oncology (CSCO) updated its guidelines for the diagnosis and treatment of esophageal cancer in 2026. In this article, the major updates of the 2026 CSCO guideline are systematically reviewed through a comparison with the 2025 version, together with a comparative analysis of relevant recommendations from the Japan Esophageal Society (JES), the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology (ESMO). The key revisions in the 2026 CSCO guideline include the following: first, treatment strategies for esophageal squamous cell carcinoma and adenocarcinoma are listed separately for the first time, highlighting biological heterogeneity and subtype-specific evidence adaptation; second, the postoperative management principles after endoscopic submucosal dissection (ESD) for early esophageal cancer are further clarified, particularly emphasizing risk stratification of lymph node metastasis according to submucosal invasion subtypes in T_1b disease; third, the indications for perioperative FLOT (oxaliplatin + docetaxel + fluorouracil + leucovorin) combined with immunotherapy in adenocarcinoma of the esophagogastric junction are more clearly defined, stressing strict patient selection according to programmed death-ligand 1 (PD-L1) expression, tumor area positivity score (TAP), preoperative nodal status, and pathological subtype. Compared with the 2025 version, the 2026 CSCO guideline further emphasizes histology-oriented precision treatment, risk-adapted clinical decision-making, and routine multidisciplinary management. In comparison with international guidelines, the 2026 CSCO guideline better reflects the Chinese clinical reality characterized by a predominance of squamous cell carcinoma, regional disparities in medical resources, and differences in treatment accessibility. These updates are expected to further promote the transition of esophageal cancer management in China from a uniform approach to a more individualized and precision-based strategy.

Key words：Esophageal neoplasms; Chinese Society of Clinical Oncology; Guideline; Squamous cell carcinoma; Adenocarcinoma; Endoscopic submucosal dissection; Immunotherapy

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