Interpretation of the NCCN guidelines for non-small cell lung cancer (version 3, 2026) and practical recommendations for radiology

FAN Rongrong; WANG Yun; XIAO Yi

doi:10.19732/j.cnki.2096-6210.2026.02.014

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Interpretation of the NCCN guidelines for non-small cell lung cancer (version 3, 2026) and practical recommendations for radiology

Guidelines and Standards | 更新时间：2026-05-07

- Interpretation of the NCCN guidelines for non-small cell lung cancer (version 3, 2026) and practical recommendations for radiology
- Oncoradiology Vol. 35, Issue 2, Pages: 330-340(2026)
- 作者机构：
  
  海军军医大学第二附属医院放射诊断科，上海 200003
- 作者简介：
- 基金信息：
  
  Shanghai Shenkang Hospital Development Center Diagnosis and Treatment Technology Promotion and Optimization Management Project(SHDC22025311-A)
- DOI：10.19732/j.cnki.2096-6210.2026.02.014
  CLC： R734.2;R445
- Received：30 March 2026，
  
  Revised：2026-04-14，
  
  Accepted：14 April 2026，
  
  Published：28 April 2026
- 稿件说明：
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樊荣荣, 望　云, 萧　毅. NCCN 2026年V3版非小细胞肺癌指南解读与影像科实践建议［J］. 肿瘤影像学, 2026, 35(2): 330-340.

FAN R　R, WANG Y, XIAO YCitation:. Interpretation of the NCCN guidelines for non-small cell lung cancer (version 3, 2026) and practical recommendations for radiology［J］. Oncoradiology, 2026, 35(2): 330-340.
樊荣荣, 望　云, 萧　毅. NCCN 2026年V3版非小细胞肺癌指南解读与影像科实践建议［J］. 肿瘤影像学, 2026, 35(2): 330-340. DOI： 10.19732/j.cnki.2096-6210.2026.02.014.

FAN R　R, WANG Y, XIAO YCitation:. Interpretation of the NCCN guidelines for non-small cell lung cancer (version 3, 2026) and practical recommendations for radiology［J］. Oncoradiology, 2026, 35(2): 330-340. DOI： 10.19732/j.cnki.2096-6210.2026.02.014.

摘要

中国的肺癌发病率与死亡率均居各类癌症之首，给医疗行业带来巨大挑战。非小细胞肺癌（non-small cell lung cancer，NSCLC）约占肺癌总病例数的85%，是全球范围内恶性肿瘤相关死亡的首要原因。美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）NSCLC临床实践指南（2026年V3版）作为全球肺癌诊疗的权威参考标准，更新了TNM分期体系，优化了肺癌筛查、诊断、分期、治疗监测及复发评估全流程的影像学相关内容，新增多项贴合临床实际的评估规范与特殊场景处理建议。本文旨在解读NCCN 2026年V3版NSCLC指南中与影像学密切相关的内容，并为影像科医师的临床实践、报告规范及多学科协作提供系统性建议。

Abstract

Lung cancer ranks first in both incidence and mortality among all malignant neoplasms in China

presenting a substantial challenge to the healthcare system. Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancer cases and represents the leading cause of cancer-related mortality worldwide. As a globally authoritative benchmark for the diagnosis and management of lung cancer

the National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology: NSCLC (version 3.2026) issued by the NCCN has updated the TNM staging system

refined imaging-related components throughout the entire continuum of lung cancer screening

diagnosis

staging

treatment response monitoring

and recurrence assessment

and incorporated multiple clinically oriented evaluation criteria and recommendations for the management of specific clinical scenarios. This article sought to interpret the imaging-relevant sections of the 2026 version 3 NCCN NSCLC guidelines and provide systematic guidance for clinical practice

standardized reporting

and multidisciplinary collaboration among radiologists.

关键词

Keywords

references

National Comprehensive Cancer Network . NCCN clinical practice guidelines in oncology: non-small cell lung cancer version 3 . 2026［EB/OL］. （ 2025-12-24 ）［ 2026-03-30 ］. https://www.nccn.org/guidelines https://www.nccn.org/guidelines .

中国医疗保健国际交流促进会肿瘤内科学分会 , 中国医师协会肿瘤医师分会 . Ⅳ期原发性肺癌中国治疗指南（2026版）［J］. 中华肿瘤杂志 , 2026 , 48 ( 1 ): 1 - 43 .

Society of Medical Oncology , China International Exchange and Promotive Association for Medical and Health Care , Chinese Medical Doctor Association Society of Clinical Oncologists . China clinical practice guideline for stage Ⅳ primary lung cancer (2026 edition) ［J］. Chin J Oncol , 2026 , 48 ( 1 ): 1 - 43 .

National Comprehensive Cancer Network . NCCN clinical practice guidelines in oncology: lung cancer screening version 1 . 2026［EB/OL］. （ 2025-09-16 ）［ 2026-03-30 ］. https://www.nccn.org/guidelines https://www.nccn.org/guidelines .

POTTER A L , XU N N , SENTHIL P , et al . Pack-year smoking history: an inadequate and biased measure to determine lung cancer screening eligibility ［J］. J Clin Oncol , 2024 , 42 ( 17 ): 2026 - 2037 .

MATAKIDOU A , EISEN T , HOULSTON R S . Systematic review of the relationship between family history and lung cancer risk ［J］. Br J Cancer , 2005 , 93 ( 7 ): 825 - 833 .

DRISCOLL T , NELSON D I , STEENLAND K , et al . The global burden of disease due to occupational carcinogens ［J］. Am J Ind Med , 2005 , 48 ( 6 ): 419 - 431 .

YANG P . Alpha1-antitrypsin deficiency carriers, tobacco smoke, chronic obstructive pulmonary disease, and lung cancer risk ［J］. Arch Intern Med , 2008 , 168 ( 10 ): 1097 .

HUBBARD R , VENN A , LEWIS S , et al . Lung cancer and cryptogenic fibrosing alveolitis: a population-based cohort study ［J］. Am J Respir Crit Care Med , 2000 , 161 ( 1 ): 5 - 8 .

中国肺癌早诊早治专家组 , 中国西部肺癌研究协作中心 . 中国肺癌低剂量CT筛查指南（2025年版）［J］. 中国肺癌杂志 , 2025 , 28 ( 12 ): 887 - 895 .

China Lung Cancer Early Detection and Treatment Expert Group , China Western Lung Cancer Research Collaboration Center . China national lung cancer screening guideline with low-dose computed tomography (2025 version) ［J］. Chin J Lung Cancer , 2025 , 28 ( 12 ): 887 - 895 .

KRIST A H , DAVIDSON K W , MANGIONE C M , et al . Screening for lung cancer: US preventive services task force recommendation statement ［J］. JAMA , 2021 , 325 ( 10 ): 962 .

中华医学会健康管理学分会 , 中华医学会放射学分会 , 中华健康管理学杂志编辑委员会 . 肺癌筛查及肺结节健康管理专家共识（2025版）［J］. 中华健康管理学杂志 , 2025 , 19 ( 10 ): 759 - 769 .

Chinese Medical Association Health Management Branch , Chinese Medical Association Radiology Branch , Editorial Board of Chinese Journal of Health Management . Expert consensus on lung cancer screening and pulmonary nodule health management (2025 Edition) ［J］. Chin J Health Manag , 2025 , 19 ( 10 ): 759 - 769 .

WANG L J , QI Y , LIU A L , et al . Opportunistic screening with low-dose computed tomography and lung cancer mortality in China ［J］. JAMA Netw Open , 2023 , 6 ( 12 ): e2347176 .

XUE F Z . Notice of retraction and replacement . Wang L , et al. opportunistic screening with low-dose computed tomography and lung cancer mortality in China. JAMA Netw Open. 2023 ; 6 ( 12 ): E2347176 ［J］. JAMA Netw Open, 2024 , 7 ( 9 ): e2438532 .

HERDER G J , VAN TINTEREN H , GOLDING R P , et al . Clinical prediction model to characterize pulmonary nodules validation and added value of 18 F-fluorodeoxyglucose positron emission tomography ［J］. Chest , 2005 , 128 ( 4 ): 2490 - 2496 .

TAMMEMÄGI M C , CHURCH T R , HOCKING W G , et al . Evaluation of the lung cancer risks at which to screen ever- and never-smokers: screening rules applied to the PLCO and NLST cohorts ［J］. PLoS Med , 2014 , 11 ( 12 ): e1001764 .

MACMAHON H , NAIDICH D P , GOO J M , et al . Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017 ［J］. Radiology , 2017 , 284 ( 1 ): 228 - 243 .

XIE D C , ZHANG L , HE N , et al . Overdiagnosis of lung cancer due to the introduction of low-dose computed tomography in average-risk populations in the people’s republic of China ［J］. J Thorac Oncol , 2025 , 20 ( 7 ): 884 - 896 .

WANG M Y , LIN S Q , HE N , et al . The introduction of low-dose CT imaging and lung cancer overdiagnosis in Chinese women ［J］. CHEST , 2023 , 163 ( 1 ): 239 - 250 .

LIU M W , LI M , ZHENG R S , et al . Comparison of 10-year survival outcomes between CT surveillance and surgery for ground-glass nodules ［J］. Radiology , 2025 , 317 ( 1 ): e250366 .

WU H X , FU F Q , YE T , et al . Active surveillance of multifocal ground-glass opacities: results of a prospective multicenter trial (ECTOP1021) ［J］. J Thorac Oncol , 2026 , 21 ( 1 ): 150 - 159 .

PINSKY P F , GIERADA D S , BLACK W , et al . Performance of lung-RADS in the national lung screening trial: a retrospective assessment ［J］. Ann Intern Med , 2015 , 162 ( 7 ): 485 - 491 .

YIP R , HENSCHKE C I , XU D M , et al . Lung cancers manifesting as part-solid nodules in the national lung screening trial ［J］. AJR Am J Roentgenol , 2017 , 208 ( 5 ): 1011 - 1021 .

NAIDICH D P , BANKIER A A , MACMAHON H , et al . Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society ［J］. Radiology , 2013 , 266 ( 1 ): 304 - 317 .

CHANG B , HWANG J H , CHOI Y H , et al . Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan ［J］. Chest , 2013 , 143 ( 1 ): 172 - 178 .

MCWILLIAMS A , TAMMEMAGI M C , MAYO J R , et al . Probability of cancer in pulmonary nodules detected on first screening CT ［J］. N Engl J Med , 2013 , 369 ( 10 ): 910 - 919 .

CHELALA L , HOSSAIN R , KAZEROONI E A , et al . Lung-RADS version 1.1: challenges and a look ahead, from the AJR special series on radiology reporting and data systems ［J］. Am J Roentgenol , 2021 , 216 ( 6 ): 1411 - 1422 .

HAMMER M M , PALAZZO L L , KONG C Y , et al . Cancer risk in subsolid nodules in the national lung screening trial ［J］. Radiology , 2019 , 293 ( 2 ): 441 - 448 .

ASAMURA H , NISHIMURA K K , GIROUX D J , et al . IASLC lung cancer staging project: the new database to inform revisions in the ninth edition of the TNM classification of lung cancer ［J］. J Thorac Oncol , 2023 , 18 ( 5 ): 564 - 575 .

ZHENG R , SHEN Q , MARDEKIAN S , et al . Molecular profiling of key driver genes improves staging accuracy in multifocal non-small cell lung cancer ［J］. J Thorac Cardiovasc Surg , 2020 , 160 ( 2 ): e71 - e79 .

MEYERS B F , HADDAD F , SIEGEL B A , et al . Cost-effectiveness of routine mediastinoscopy in computed tomography-and positron emission tomography-screened patients with stage Ⅰ lung cancer ［J］. J Thorac Cardiovasc Surg , 2006 , 131 ( 4 ): 822 - 829.e2 .

ZHANG Y , QIAN B , SONG Q P , et al . Phase Ⅲ study of mediastinal lymph node dissection for ground glass opacity-dominant lung adenocarcinoma ［J］. J Clin Oncol , 2025 , 43 ( 28 ): 3081 - 3089 .

SILVESTRI G A , GONZALEZ A V , JANTZ M A , et al . Methods for staging non-small cell lung cancer diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines ［J］. Chest , 2013 , 143 ( 5 ): e211 S-e250S.

DARLING G E , MAZIAK D E , INCULET R I , et al . Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial ［J］. J Thorac Oncol , 2011 , 6 ( 8 ): 1367 - 1372 .

DE WEVER W , STROOBANTS S , COOLEN J , et al . Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration ［J］. Eur Respir J , 2009 , 33 ( 1 ): 201 - 212 .

KUŻDŻAŁ A , KUŻDŻAŁ B , MOSZCZYŃSKI K , et al . PET-CT in mediastinal staging of non-small cell lung cancer: analysis of false results ［J］. Pol J Radiol , 2025 , 90 : 234 - 238 .

NAKAGAWA K , GARON E B , SETO T , et al . Ramucirumab plus erlotinib in patients with untreated, EGFR-mutated, advanced non-small-cell lung cancer (RELAY): a randomised, double-blind, placebo-controlled, phase 3 trial ［J］. Lancet Oncol , 2019 , 20 ( 12 ): 1655 - 1669 .

KAWASHIMA Y , FUKUHARA T , SAITO H , et al . Bevacizumab plus erlotinib versus erlotinib alone in Japanese patients with advanced, metastatic, EGFR-mutant non-small-cell lung cancer (NEJ026): overall survival analysis of an open-label, randomised, multicentre, phase 3 trial ［J］. Lancet Respir Med , 2022 , 10 ( 1 ): 72 - 82 .

CHIOU V L , BUROTTO M . Pseudoprogression and immune-related response in solid tumors ［J］. J Clin Oncol , 2015 , 33 ( 31 ): 3541 - 3543 .

CASCONE T , WEISSFERDT A , GODOY M C B , et al . Nodal immune flare mimics nodal disease progression following neoadjuvant immune checkpoint inhibitors in non-small cell lung cancer ［J］. Nat Commun , 2021 , 12 ( 1 ): 5045 .

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