| {"id": "l1-sample-1c4540f592a065284cecaaa5", "question": "根据 CSCO 2025，治疗前常规加做 PET/CT 的“高远处转移风险”人群，哪一项表述最准确？", "options": {"A": "仅病理为未分化型，但分期早且 EBV DNA 不高", "B": "T1N0M0，且 EBV DNA 低水平或阴性", "C": "N0–1 且 EBV DNA >4000 copies/mL，或 N2–3，或 T3–4", "D": "原发灶局限鼻咽、无任何高危因素者均应常规 PET/CT"}, "answer": "C", "choices": ["A. 仅病理为未分化型，但分期早且 EBV DNA 不高", "B. T1N0M0，且 EBV DNA 低水平或阴性", "C. N0–1 且 EBV DNA >4000 copies/mL，或 N2–3，或 T3–4", "D. 原发灶局限鼻咽、无任何高危因素者均应常规 PET/CT"], "explanation": "CSCO 将高远处转移风险的触发条件写得很具体：N0–1 但 EBV DNA >4000 copies/mL，或 N2–3，或 T3–4。对这类患者，治疗前常规加做 PET/CT 更符合指南；单纯“未分化型”而无分期或 EBV 风险升高，并不是该条推荐的直接依据。", "source": "CSCO 2025 第2.1节影像诊断（表1，高转移风险分层与 PET/CT 指征）；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 第2.1节影像诊断（表1，高转移风险分层与 PET/CT 指征）", "NCCN 2025 NASO-1 Workup"], "answer_text": "N0–1 且 EBV DNA >4000 copies/mL，或 N2–3，或 T3–4", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-7662f5f79a5812f9b86a9fc7", "question": "根据 CSCO 2025，对极低远处转移风险的确诊鼻咽癌患者，以下哪项最符合“先分层、后升级”的筛查策略？", "options": {"A": "直接以全身 PET/CT 作为所有患者的常规首选", "B": "以 PET/MRI 替代胸部 CT 与腹部评估", "C": "先行脑 MRI 与骨髓穿刺，以排除隐匿远转", "D": "先行腹部超声；如结果可疑，再补充上腹部增强 CT 或 MRI"}, "answer": "D", "choices": ["A. 直接以全身 PET/CT 作为所有患者的常规首选", "B. 以 PET/MRI 替代胸部 CT 与腹部评估", "C. 先行脑 MRI 与骨髓穿刺，以排除隐匿远转", "D. 先行腹部超声；如结果可疑，再补充上腹部增强 CT 或 MRI"], "explanation": "CSCO 的核心并不是“所有人一步到位做 PET/CT”，而是风险分层后逐级升级检查。对极低远转风险患者，可先做腹部超声，异常时再补充上腹部增强 CT/MRI，以减少过度检查并保持筛查效率。", "source": "CSCO 2025 第2.1节影像诊断（表1，远处转移评估路径）；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 第2.1节影像诊断（表1，远处转移评估路径）", "NCCN 2025 NASO-1 Workup"], "answer_text": "先行腹部超声；如结果可疑，再补充上腹部增强 CT 或 MRI", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-1f7c06723e7868f5a28d05a1", "question": "根据 CSCO 2025，结构化影像报告对鼻咽癌临床管理的直接价值，以下哪项最符合指南表述？", "options": {"A": "主要服务科研，临床决策价值有限", "B": "有助于减少侵犯范围和淋巴结信息遗漏，并为精准分期与治疗决策提供标准化信息", "C": "仅在复发再分期时有价值，初诊意义有限", "D": "可替代病理并直接给出组织学分型"}, "answer": "B", "choices": ["A. 主要服务科研，临床决策价值有限", "B. 有助于减少侵犯范围和淋巴结信息遗漏，并为精准分期与治疗决策提供标准化信息", "C. 仅在复发再分期时有价值，初诊意义有限", "D. 可替代病理并直接给出组织学分型"], "explanation": "结构化影像报告的核心价值在于规范记录原发灶侵犯、淋巴结状态及关键解剖信息，减少遗漏并服务于精准分期、靶区勾画和治疗决策。它不能替代病理，也不限于复发场景。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "有助于减少侵犯范围和淋巴结信息遗漏，并为精准分期与治疗决策提供标准化信息", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-37503f36da80ddffc1fa3cdf", "question": "MRI提示蝶骨基底部轻度骨硬化，但病灶与原发灶不连续，且各序列信号不与原发灶一致。对该影像学表现最合理的判断是？", "options": {"A": "应直接按N3处理", "B": "不能仅凭此表现升为T3", "C": "可直接定为T4", "D": "可直接定为T3"}, "answer": "B", "choices": ["A. 应直接按N3处理", "B. 不能仅凭此表现升为T3", "C. 可直接定为T4", "D. 可直接定为T3"], "explanation": "最新版NPC分期强调：早期颅底骨质受侵不能仅凭骨硬化或单个序列异常判断，需与原发灶连续且MRI各序列信号一致。这个陷阱是第九版分期的核心边界之一。", "source": "CSCO 2025 §2.1–2.2；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1–2.2", "NCCN 2025 NASO-1 Workup"], "answer_text": "不能仅凭此表现升为T3", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-3e36776cb7848cf0ce3806f2", "question": "关于 PET/MRI 在鼻咽癌治疗前评估中的定位，最符合 CSCO 2025 表述的是：", "options": {"A": "已可完全替代标准 PET/CT 与鼻咽+颈部 MRI 路径", "B": "仅适用于所有早期患者", "C": "仍处探索阶段，尚不能替代标准 PET/CT 与 MRI 路径", "D": "只能用于复发后评估"}, "answer": "C", "choices": ["A. 已可完全替代标准 PET/CT 与鼻咽+颈部 MRI 路径", "B. 仅适用于所有早期患者", "C. 仍处探索阶段，尚不能替代标准 PET/CT 与 MRI 路径", "D. 只能用于复发后评估"], "explanation": "CSCO 对 PET/MRI 的态度是“有潜力，但尚未替代标准路径”。受设备、场强、增强条件、价格与证据成熟度限制，PET/MRI 目前仍处探索阶段，不能直接替代常规 PET/CT 与 MRI 组合。", "source": "CSCO 2025 §2.1 影像诊断（PET/MRI定位）；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断（PET/MRI定位）", "NCCN 2025 NASO-1 Workup"], "answer_text": "仍处探索阶段，尚不能替代标准 PET/CT 与 MRI 路径", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-91bf6c62b123334b7aadfd4b", "question": "根据 CSCO 2025，对鼻咽癌颅底骨侵犯的影像学判定，最符合指南的是：", "options": {"A": "只要MRI稍异常即可", "B": "病灶需与原发灶连续，且MRI信号与原发灶一致", "C": "任何翼突基底部改变都算T4", "D": "只要CT有骨质硬化即可"}, "answer": "B", "choices": ["A. 只要MRI稍异常即可", "B. 病灶需与原发灶连续，且MRI信号与原发灶一致", "C. 任何翼突基底部改变都算T4", "D. 只要CT有骨质硬化即可"], "explanation": "CSCO强调骨侵犯应与原发灶连续，且MRI各序列信号应与原发灶一致；单纯硬化不足以诊断。", "source": "CSCO 2025 §2.1 影像诊断；CSCO 2025 §2.3 分期注释（颅底骨侵犯判定）", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断", "CSCO 2025 §2.3 分期注释（颅底骨侵犯判定）"], "answer_text": "病灶需与原发灶连续，且MRI信号与原发灶一致", "domain": "诊断、病理与初始评估", "source_type": "CSCO-only", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-3719fef52e654f77444dbc94", "question": "根据 CSCO 2025，对早期颅底骨质受侵的影像诊断，特别强调：", "options": {"A": "仅有 MRI/CT 骨质硬化不足以诊断 T3，需在所有 MRI 序列上与原发肿瘤信号一致", "B": "CT/MRI 只要出现骨质硬化即可诊断 T3", "C": "所有颅底骨质异常都应按 T4 处理", "D": "只要蝶骨基底部或翼突异常即直接降为 T2"}, "answer": "A", "choices": ["A. 仅有 MRI/CT 骨质硬化不足以诊断 T3，需在所有 MRI 序列上与原发肿瘤信号一致", "B. CT/MRI 只要出现骨质硬化即可诊断 T3", "C. 所有颅底骨质异常都应按 T4 处理", "D. 只要蝶骨基底部或翼突异常即直接降为 T2"], "explanation": "2025版虽未直接把早期颅底骨侵犯降为 T2，但强调应严格规范影像诊断，仅有骨质硬化不足以定 T3。", "source": "CSCO 2025 §2.1 影像诊断；CSCO 2025 §2.3 分期注释（颅底骨侵犯判读要点）；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断", "CSCO 2025 §2.3 分期注释（颅底骨侵犯判读要点）", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "仅有 MRI/CT 骨质硬化不足以诊断 T3，需在所有 MRI 序列上与原发肿瘤信号一致", "domain": "诊断、病理与初始评估", "source_type": "CSCO-only", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-A. 影像学与原发灶评估"} |
| {"id": "l1-sample-6c3db22f88f351344b0774fc", "question": "根据 CSCO 2025，关于鼻咽原发灶侵犯范围评估的首选影像学，哪一项最符合指南？", "options": {"A": "颈部超声联合骨显像作为局部首选影像", "B": "鼻咽平扫+增强MRI", "C": "FDG-PET/CT作为原发灶首选并替代MRI", "D": "鼻咽平扫+增强CT作为常规首选"}, "answer": "B", "choices": ["A. 颈部超声联合骨显像作为局部首选影像", "B. 鼻咽平扫+增强MRI", "C. FDG-PET/CT作为原发灶首选并替代MRI", "D. 鼻咽平扫+增强CT作为常规首选"], "explanation": "CSCO将鼻咽平扫+增强MRI列为原发灶侵犯范围评估首选，因为其对软组织、咽旁间隙、颅底骨与神经受侵显示更优。增强CT多用于MRI禁忌或补充骨质显示，PET/CT并不替代原发灶MRI。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "鼻咽平扫+增强MRI", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-a10005f8559addbd49e60cd8", "question": "根据 CSCO 2025，对 MRI 尚未达到转移标准的小颈部淋巴结，若 PET/CT 出现明确异常摄取，最符合指南的处理是：", "options": {"A": "按转移淋巴结纳入分期与靶区评估", "B": "仍按反应性淋巴结处理，仅建议短期随访", "C": "只有同时出现坏死或环形强化时才可视为转移", "D": "必须先行开放活检后方可上调分期"}, "answer": "A", "choices": ["A. 按转移淋巴结纳入分期与靶区评估", "B. 仍按反应性淋巴结处理，仅建议短期随访", "C. 只有同时出现坏死或环形强化时才可视为转移", "D. 必须先行开放活检后方可上调分期"], "explanation": "CSCO 对这一场景强调“综合影像判读”。对于 MRI 尚未达阳性标准的小淋巴结，若 PET/CT 呈阳性，应按转移淋巴结处理，而不是机械等待其进一步增大，或把坏死、开放活检设为先决条件。", "source": "CSCO 2025 第2.1节影像诊断（表1，小淋巴结 PET/CT 阳性按转移处理）+ 第2.2节病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 第2.1节影像诊断（表1，小淋巴结 PET/CT 阳性按转移处理）+ 第2.2节病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "按转移淋巴结纳入分期与靶区评估", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-c954e6ced0f1c284a1ff76d4", "question": "根据 CSCO 2025，当鼻咽原发灶尚未明确、但出现颈部淋巴结肿大或非常规区域淋巴结可疑转移时，下一步最符合指南的是：", "options": {"A": "在影像引导下对可疑淋巴结行穿刺/活检以明确病理与原发线索", "B": "经验性按鼻咽癌直接开始放化疗", "C": "仅凭 EBV DNA 阳性即可视为鼻咽癌转移", "D": "直接做开放性整块淋巴结切除活检作为首选"}, "answer": "A", "choices": ["A. 在影像引导下对可疑淋巴结行穿刺/活检以明确病理与原发线索", "B. 经验性按鼻咽癌直接开始放化疗", "C. 仅凭 EBV DNA 阳性即可视为鼻咽癌转移", "D. 直接做开放性整块淋巴结切除活检作为首选"], "explanation": "CSCO 对原发灶不明的颈部淋巴结肿大、非常规区域淋巴结或影像可疑小淋巴结，均强调进一步做影像引导下穿刺/活检，以明确病理、辅助寻找原发并优化分期与靶区设计。经验性治疗、直接开放切除或仅凭 EBV DNA 定性都不符合指南优先路径。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "在影像引导下对可疑淋巴结行穿刺/活检以明确病理与原发线索", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-73790c9fe25803a58aa10e0f", "question": "根据 CSCO 2025，关于鼻咽癌中 PET/CT 与 MRI 的分工，下列哪项最符合指南逻辑？", "options": {"A": "两者功能等价，仅根据设备可及性任选其一即可", "B": "MRI 仍是原发灶与邻近软组织侵犯评估首选；PET/CT 更有助于小淋巴结和远处转移评估", "C": "MRI 主要用于远处转移筛查，PET/CT 主要用于原发灶 T 分期", "D": "PET/CT 可替代 MRI 作为原发灶侵犯范围评估首选"}, "answer": "B", "choices": ["A. 两者功能等价，仅根据设备可及性任选其一即可", "B. MRI 仍是原发灶与邻近软组织侵犯评估首选；PET/CT 更有助于小淋巴结和远处转移评估", "C. MRI 主要用于远处转移筛查，PET/CT 主要用于原发灶 T 分期", "D. PET/CT 可替代 MRI 作为原发灶侵犯范围评估首选"], "explanation": "CSCO 明确将 MRI 作为原发灶侵犯范围与局部 T 分期的首选影像；PET/CT 的优势在于小淋巴结识别、远处转移筛查以及部分复发/纤维化鉴别。因此两者是互补关系，而不是相互替代。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "MRI 仍是原发灶与邻近软组织侵犯评估首选；PET/CT 更有助于小淋巴结和远处转移评估", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-a96260063376cb339975fe61", "question": "根据 CSCO 2025，在鼻咽镜可达且可见可疑原发灶的前提下，获取组织学诊断的首选方式通常是？", "options": {"A": "鼻咽镜下肿块活检", "B": "外周血 ctDNA 检测", "C": "PET/CT 代替病理取材", "D": "颈部开放性淋巴结活检作为首选"}, "answer": "A", "choices": ["A. 鼻咽镜下肿块活检", "B. 外周血 ctDNA 检测", "C. PET/CT 代替病理取材", "D. 颈部开放性淋巴结活检作为首选"], "explanation": "在原发灶可达且可见的前提下，CSCO 将鼻咽镜下肿块活检作为获取组织学诊断的首选方式。液体标志物和影像都不能替代病理；颈部开放活检也不是首选路径。题干加入“原发灶可达”这一前提，是为了确保唯一最佳答案。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "鼻咽镜下肿块活检", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-0441177c2b985bef57a48565", "question": "根据 CSCO 2025，若鼻咽原发灶难以取得诊断性组织，下一步最符合指南的补救策略是：", "options": {"A": "放弃组织学诊断，按影像直接开始治疗", "B": "先完成放疗，待复发后再补病理", "C": "对颈部可疑转移淋巴结行穿刺或活检以获得病理", "D": "仅凭 EBV 抗体阳性即可确诊鼻咽癌"}, "answer": "C", "choices": ["A. 放弃组织学诊断，按影像直接开始治疗", "B. 先完成放疗，待复发后再补病理", "C. 对颈部可疑转移淋巴结行穿刺或活检以获得病理", "D. 仅凭 EBV 抗体阳性即可确诊鼻咽癌"], "explanation": "如果鼻咽原发灶无法安全或有效获得诊断性组织，CSCO 允许通过颈部可疑转移淋巴结穿刺或活检来取得病理。影像学、EBV 血清学或延后补病理都不能替代这一关键步骤。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "对颈部可疑转移淋巴结行穿刺或活检以获得病理", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-95ed214f0d9c5ca2fd9f14f0", "question": "根据 CSCO 2025，当常规形态学尚不能明确诊断为鼻咽癌时，最符合指南的补充病理策略是：", "options": {"A": "补做pancytokeratin免疫组化和/或EBER原位杂交", "B": "补做p16免疫组化和HPV RNA原位杂交作为首选", "C": "补做S100与SOX10以首先排查黑色素细胞肿瘤", "D": "补做TTF-1与Napsin A以首先排查肺腺癌"}, "answer": "A", "choices": ["A. 补做pancytokeratin免疫组化和/或EBER原位杂交", "B. 补做p16免疫组化和HPV RNA原位杂交作为首选", "C. 补做S100与SOX10以首先排查黑色素细胞肿瘤", "D. 补做TTF-1与Napsin A以首先排查肺腺癌"], "explanation": "当形态学不足以明确诊断鼻咽癌时，CSCO建议补做pancytokeratin和/或EBER等辅助检测，以支持上皮来源和EBV相关性判断；其余组合更偏向其他肿瘤谱系的鉴别。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "补做pancytokeratin免疫组化和/或EBER原位杂交", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-65e3a6b8cf6802c1bd32eedc", "question": "根据 CSCO 2025，关于我国流行区鼻咽癌的主要病理谱，哪一项最符合指南表述？", "options": {"A": "以角化性鳞癌为主体，非角化性癌相对少见", "B": "以非角化性癌最常见，其中又可分为分化型和未分化型", "C": "几乎所有病例均应直接归为未分化癌", "D": "以基底样鳞癌最常见，且与 EBV 关系最密切"}, "answer": "B", "choices": ["A. 以角化性鳞癌为主体，非角化性癌相对少见", "B. 以非角化性癌最常见，其中又可分为分化型和未分化型", "C. 几乎所有病例均应直接归为未分化癌", "D. 以基底样鳞癌最常见，且与 EBV 关系最密切"], "explanation": "在我国流行区，鼻咽癌以非角化性癌最常见，并进一步分为分化型和未分化型。角化性鳞癌与基底样鳞癌都不是主体；把所有病例简单写成“未分化癌”也不符合病理分型规范。", "source": "CSCO 2025 第2.2节病理学诊断（病理亚型）；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 第2.2节病理学诊断（病理亚型）", "NCCN 2025 NASO-1 Workup"], "answer_text": "以非角化性癌最常见，其中又可分为分化型和未分化型", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-82e7769d38664f54ed42cc3c", "question": "根据 NCCN 2025，当囊性颈部淋巴结作为首发表现时，最符合指南的诊断取材策略是：", "options": {"A": "应先做开放性切除活检，再考虑针吸", "B": "应先经验性抗感染治疗，待肿块持续存在后再说", "C": "单纯触诊下 FNA 已足够，通常优于图像引导穿刺", "D": "US 或 CT 引导下的针吸/穿刺可提高诊断收益，优于单纯触诊 FNA"}, "answer": "D", "choices": ["A. 应先做开放性切除活检，再考虑针吸", "B. 应先经验性抗感染治疗，待肿块持续存在后再说", "C. 单纯触诊下 FNA 已足够，通常优于图像引导穿刺", "D. US 或 CT 引导下的针吸/穿刺可提高诊断收益，优于单纯触诊 FNA"], "explanation": "NCCN 在头颈原发不明/囊性颈部淋巴结的诊断路径中强调，US 或 CT 引导下针吸/穿刺可提高诊断收益，通常优于单纯触诊 FNA。开放切除活检和经验性延迟处理都不应作为首选。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "US 或 CT 引导下的针吸/穿刺可提高诊断收益，优于单纯触诊 FNA", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-6513d4f3ab295e0f09230357", "question": "根据 NCCN 2025，对不可切除或转移性疾病、且计划接受系统治疗的患者，若需追加组织取材，最符合指南目的导向的是：", "options": {"A": "尽量获取 core biopsy，以便后续免疫与基因组辅助检测", "B": "细胞学阳性后不再需要更多组织", "C": "仅检测外周血 EBV DNA 即可取代组织学扩展检测", "D": "先开始治疗，病理类型以后再补"}, "answer": "A", "choices": ["A. 尽量获取 core biopsy，以便后续免疫与基因组辅助检测", "B. 细胞学阳性后不再需要更多组织", "C. 仅检测外周血 EBV DNA 即可取代组织学扩展检测", "D. 先开始治疗，病理类型以后再补"], "explanation": "NCCN 特别指出，对不可切除或转移性、且拟进入系统治疗的患者，core biopsy 有助于后续免疫标志物与基因组辅助检测。细胞学阳性并不总能满足后续全部检测需求，因此“追加更多组织”的价值是明确的。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "尽量获取 core biopsy，以便后续免疫与基因组辅助检测", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-a7a8dfb30e639fba94e09c16", "question": "囊性颈部淋巴结作为初始诊断线索时，哪一种取材策略更能提高诊断收益？", "options": {"A": "单纯触诊下 FNA", "B": "先经验性抗感染后再决定是否穿刺", "C": "直接开放性整块切除活检", "D": "图像引导下（超声或 CT）穿刺"}, "answer": "D", "choices": ["A. 单纯触诊下 FNA", "B. 先经验性抗感染后再决定是否穿刺", "C. 直接开放性整块切除活检", "D. 图像引导下（超声或 CT）穿刺"], "explanation": "NCCN 在 NASO-1 Workup 中专门提醒：对囊性颈部淋巴结，图像引导下穿刺通常优于单纯触诊 FNA。它的价值在于提高命中率并减少“看似穿到了、实际上没取得有效细胞成分”的情况。", "source": "NCCN 2025 NASO-1 Workup（取材/附加检测脚注）；CSCO 2025 §2.2 病理学诊断", "evidence_anchors": ["NCCN 2025 NASO-1 Workup（取材/附加检测脚注）", "CSCO 2025 §2.2 病理学诊断"], "answer_text": "图像引导下（超声或 CT）穿刺", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-83041f133076fa6b89d29a02", "question": "对不可切除或转移性 NPC、且已计划进入全身治疗的患者，额外获取 core biopsy 最重要的价值是：", "options": {"A": "满足后续免疫与基因组辅助检测需要", "B": "替代 MRI", "C": "替代病理诊断本身", "D": "只为了 HPV 检测"}, "answer": "A", "choices": ["A. 满足后续免疫与基因组辅助检测需要", "B. 替代 MRI", "C. 替代病理诊断本身", "D. 只为了 HPV 检测"], "explanation": "NCCN 在 Workup 中明确提到：对不可切除或转移性、并计划接受系统治疗的患者，额外获取 core biopsy 的价值之一，是满足后续 biomarker / immune-genomic 辅助检测需求，而不是替代病理或影像学检查。", "source": "NCCN 2025 NASO-1 Workup（取材/附加检测脚注）；CSCO 2025 §2.2 病理学诊断", "evidence_anchors": ["NCCN 2025 NASO-1 Workup（取材/附加检测脚注）", "CSCO 2025 §2.2 病理学诊断"], "answer_text": "满足后续免疫与基因组辅助检测需要", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-B. 病理、取材与组织学确认"} |
| {"id": "l1-sample-e3424d962b6e8167e20342fd", "question": "按CSCO，以下哪类患者最需要纳入鼻咽癌MDT常规讨论对象？", "options": {"A": "局部晚期、复发/转移，或出现严重放疗并发症，或需要评估局部根治手段利弊的患者", "B": "所有T1N0且治疗完全标准化的患者", "C": "仅病理未分化型患者", "D": "仅儿童患者"}, "answer": "A", "choices": ["A. 局部晚期、复发/转移，或出现严重放疗并发症，或需要评估局部根治手段利弊的患者", "B. 所有T1N0且治疗完全标准化的患者", "C. 仅病理未分化型患者", "D. 仅儿童患者"], "explanation": "CSCO总则强调，MDT尤其适用于局部晚期及复发/转移患者、出现严重放疗并发症者，以及需要评估局部根治手段利弊的患者。", "source": "CSCO 2025 §1 鼻咽癌诊疗总则/MDT诊疗模式", "evidence_anchors": ["CSCO 2025 §1 鼻咽癌诊疗总则/MDT诊疗模式"], "answer_text": "局部晚期、复发/转移，或出现严重放疗并发症，或需要评估局部根治手段利弊的患者", "domain": "初治非转移性成人NPC", "source_type": "CSCO-only", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-C. 基线工作up与MDT"} |
| {"id": "l1-sample-444cead0bc71b1cab860d04c", "question": "根据 CSCO 2025，鼻咽癌 MDT 讨论对象中，除局部晚期及复发/转移患者外，还应特别纳入：", "options": {"A": "仅儿童患者", "B": "仅角化型患者", "C": "所有 T1N0 患者", "D": "出现严重放疗并发症（如鼻咽坏死、放射性脑病）的患者"}, "answer": "D", "choices": ["A. 仅儿童患者", "B. 仅角化型患者", "C. 所有 T1N0 患者", "D. 出现严重放疗并发症（如鼻咽坏死、放射性脑病）的患者"], "explanation": "CSCO MDT 章节明确指出，出现严重放疗并发症的鼻咽癌患者也属于 MDT 重点讨论对象。", "source": "CSCO 2025 §1 鼻咽癌诊疗总则/MDT诊疗模式", "evidence_anchors": ["CSCO 2025 §1 鼻咽癌诊疗总则/MDT诊疗模式"], "answer_text": "出现严重放疗并发症（如鼻咽坏死、放射性脑病）的患者", "domain": "复发/转移性成人NPC", "source_type": "CSCO-only", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-C. 基线工作up与MDT"} |
| {"id": "l1-sample-e1e0ef3cdf44602fae0751ea", "question": "根据 CSCO 2025，鼻咽癌 MDT 的 I 级推荐学科构成不包括：", "options": {"A": "病理科、核医学科、营养科、生物治疗/免疫治疗科", "B": "仅病理科和手术科，其他学科可不参加", "C": "放疗科、肿瘤内科、放射诊断科、头颈外科/耳鼻喉科", "D": "心理科、口腔科"}, "answer": "B", "choices": ["A. 病理科、核医学科、营养科、生物治疗/免疫治疗科", "B. 仅病理科和手术科，其他学科可不参加", "C. 放疗科、肿瘤内科、放射诊断科、头颈外科/耳鼻喉科", "D. 心理科、口腔科"], "explanation": "CSCO 明确给出 MDT 的多学科构成，强调放疗、内科、影像、外科、病理、核医学、营养、免疫、生物治疗、心理、口腔等共同参与。", "source": "CSCO 2025 §1 鼻咽癌诊疗总则/MDT诊疗模式", "evidence_anchors": ["CSCO 2025 §1 鼻咽癌诊疗总则/MDT诊疗模式"], "answer_text": "仅病理科和手术科，其他学科可不参加", "domain": "诊断、病理与初始评估", "source_type": "CSCO-only", "scope_major": "I. 初诊评估与诊断工作up", "scope_minor": "I-C. 基线工作up与MDT"} |
| {"id": "l1-sample-32ce7f35b40ee66e75435e46", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T1 的定义？", "options": {"A": "肿瘤侵犯咽旁间隙和/或邻近软组织", "B": "肿瘤局限鼻咽，或侵犯鼻腔/口咽但无咽旁间隙受侵", "C": "肿瘤侵犯颅底骨或鼻旁窦", "D": "肿瘤侵犯眶下裂/眼眶或明确颅神经"}, "answer": "B", "choices": ["A. 肿瘤侵犯咽旁间隙和/或邻近软组织", "B. 肿瘤局限鼻咽，或侵犯鼻腔/口咽但无咽旁间隙受侵", "C. 肿瘤侵犯颅底骨或鼻旁窦", "D. 肿瘤侵犯眶下裂/眼眶或明确颅神经"], "explanation": "第9版中，T1 的核心是“局限鼻咽，或仅侵犯鼻腔/口咽，但未进入咽旁间隙”。一旦累及咽旁间隙或邻近软组织即至少为 T2；骨结构受侵升至 T3；眶下裂、眼眶或颅神经受侵则归入 T4。", "source": "CSCO 2025 第2.3节分期（页15注释）；AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 第2.3节分期（页15注释）", "AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）"], "answer_text": "肿瘤局限鼻咽，或侵犯鼻腔/口咽但无咽旁间隙受侵", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-A. T分期与局部侵犯边界"} |
| {"id": "l1-sample-146e2618210b7a46e9af3c02", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T2 的定义？", "options": {"A": "肿瘤局限鼻咽，或仅及鼻腔/口咽", "B": "肿瘤侵犯颅底骨、鼻旁窦或颈椎", "C": "肿瘤侵犯咽旁间隙和/或邻近软组织（如翼内肌、翼外肌、椎前肌）", "D": "肿瘤侵犯眶下裂/眼眶或明确颅神经"}, "answer": "C", "choices": ["A. 肿瘤局限鼻咽，或仅及鼻腔/口咽", "B. 肿瘤侵犯颅底骨、鼻旁窦或颈椎", "C. 肿瘤侵犯咽旁间隙和/或邻近软组织（如翼内肌、翼外肌、椎前肌）", "D. 肿瘤侵犯眶下裂/眼眶或明确颅神经"], "explanation": "T2 的关键词是“咽旁间隙和/或邻近软组织受侵”。局限于鼻咽、鼻腔或口咽属于 T1；骨结构侵犯归入 T3；眶下裂、眼眶或颅神经受侵归入 T4。", "source": "CSCO 2025 第2.3节分期（页15注释）；AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 第2.3节分期（页15注释）", "AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）"], "answer_text": "肿瘤侵犯咽旁间隙和/或邻近软组织（如翼内肌、翼外肌、椎前肌）", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-A. T分期与局部侵犯边界"} |
| {"id": "l1-sample-d06615a88c34b6d20769ed2b", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T3 的定义？", "options": {"A": "肿瘤侵犯咽旁间隙和邻近软组织，但无骨结构受侵", "B": "肿瘤侵犯眶下裂、眼眶或明确颅神经", "C": "肿瘤明确侵犯颅底骨、鼻旁窦、颈椎或翼状结构等骨性结构", "D": "仅出现双侧咽后淋巴结转移"}, "answer": "C", "choices": ["A. 肿瘤侵犯咽旁间隙和邻近软组织，但无骨结构受侵", "B. 肿瘤侵犯眶下裂、眼眶或明确颅神经", "C. 肿瘤明确侵犯颅底骨、鼻旁窦、颈椎或翼状结构等骨性结构", "D. 仅出现双侧咽后淋巴结转移"], "explanation": "T3 的核心是明确骨性结构侵犯，如颅底骨、鼻旁窦、颈椎或翼状结构。单纯咽旁间隙或软组织侵犯仍属 T2；眶下裂、眼眶或颅神经受侵属于 T4；淋巴结受累不直接决定 T 分期。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "肿瘤明确侵犯颅底骨、鼻旁窦、颈椎或翼状结构等骨性结构", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-A. T分期与局部侵犯边界"} |
| {"id": "l1-sample-67246b8752a66f01a99dbd93", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 T4 的定义？", "options": {"A": "肿瘤局限鼻咽，或仅及鼻腔/口咽", "B": "明确侵犯颅神经、眶下裂/眼眶或颅内", "C": "仅见蝶骨基底部骨硬化，但缺乏连续侵犯与典型 MRI 肿瘤信号", "D": "仅见鼻旁窦侵犯而无其他高级受侵"}, "answer": "B", "choices": ["A. 肿瘤局限鼻咽，或仅及鼻腔/口咽", "B. 明确侵犯颅神经、眶下裂/眼眶或颅内", "C. 仅见蝶骨基底部骨硬化，但缺乏连续侵犯与典型 MRI 肿瘤信号", "D. 仅见鼻旁窦侵犯而无其他高级受侵"], "explanation": "T4 包括明确颅神经、眶下裂/眼眶、颅内等高级解剖结构受侵。单纯骨硬化不足以定 T3，更不能直接定 T4；鼻旁窦或其他明确骨结构侵犯通常仍归 T3。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "明确侵犯颅神经、眶下裂/眼眶或颅内", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-A. T分期与局部侵犯边界"} |
| {"id": "l1-sample-8b048f3a8a93f1937b75d3df", "question": "根据 CSCO 2025，关于早期颅底骨质受侵，最符合指南表述的是？", "options": {"A": "任何翼突改变均可定为 T3", "B": "只要 MRI 可疑即为 T3", "C": "只要 CT 有骨硬化即为 T3", "D": "需病灶与原发灶连续，且 MRI 各序列信号与原发灶一致"}, "answer": "D", "choices": ["A. 任何翼突改变均可定为 T3", "B. 只要 MRI 可疑即为 T3", "C. 只要 CT 有骨硬化即为 T3", "D. 需病灶与原发灶连续，且 MRI 各序列信号与原发灶一致"], "explanation": "最新版对早期颅底骨质受侵要求更严格：病灶应与原发灶连续，且MRI各序列信号与原发灶一致。仅凭骨硬化或单个序列可疑，不足以判为T3。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "需病灶与原发灶连续，且 MRI 各序列信号与原发灶一致", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-A. T分期与局部侵犯边界"} |
| {"id": "l1-sample-a8d9bcfc95350db5fcb3d9a7", "question": "根据 CSCO 2025，对明确眶下裂受侵的鼻咽癌，分期和高危靶区设计更应按：", "options": {"A": "T4", "B": "T3", "C": "T2", "D": "仅N分期改变"}, "answer": "A", "choices": ["A. T4", "B. T3", "C. T2", "D. 仅N分期改变"], "explanation": "CSCO最新版分期注释将眶下裂受侵归入T4。", "source": "CSCO 2025 §2.3 分期注释；CSCO 2025 §3.3 靶区勾画及剂量（眶下裂相关高危区）", "evidence_anchors": ["CSCO 2025 §2.3 分期注释", "CSCO 2025 §3.3 靶区勾画及剂量（眶下裂相关高危区）"], "answer_text": "T4", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-A. T分期与局部侵犯边界"} |
| {"id": "l1-sample-7506d12967e8571f723e776e", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，N1 的定义最符合下列哪项表述？", "options": {"A": "双侧颈部淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵", "B": "单侧颈部淋巴结和/或单、双侧咽后淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵", "C": "任一颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下", "D": "任何伴严重颈部包膜外侵的颈部淋巴结转移，即使≤6 cm且位于环状软骨以上"}, "answer": "B", "choices": ["A. 双侧颈部淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵", "B. 单侧颈部淋巴结和/或单、双侧咽后淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵", "C. 任一颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下", "D. 任何伴严重颈部包膜外侵的颈部淋巴结转移，即使≤6 cm且位于环状软骨以上"], "explanation": "第9版的 N1 仍要求病灶位于环状软骨尾侧缘以上且≤6 cm，但特别允许“单侧颈部淋巴结”和/或“单、双侧咽后淋巴结”转移。双侧颈部淋巴结更接近 N2；>6 cm、尾侧缘以下或严重颈部 ENE 则进入 N3。", "source": "CSCO 2025 第2.3节分期（页15注释）；AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 第2.3节分期（页15注释）", "AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）"], "answer_text": "单侧颈部淋巴结和/或单、双侧咽后淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部包膜外侵", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-21ee82e529a268415fe6691f", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪项最符合 N2 定义？", "options": {"A": "任一颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下", "B": "仅出现咽后淋巴结转移即可定义为 N2", "C": "双侧颈部淋巴结转移，均 ≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE", "D": "单侧颈部淋巴结转移，≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE"}, "answer": "C", "choices": ["A. 任一颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下", "B. 仅出现咽后淋巴结转移即可定义为 N2", "C. 双侧颈部淋巴结转移，均 ≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE", "D. 单侧颈部淋巴结转移，≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE"], "explanation": "N2 的关键是“双侧颈部淋巴结转移”，且均 ≤6 cm、位于环状软骨尾侧缘以上、无严重颈部 ENE。单侧颈部或咽后淋巴结受累仍可落在 N1；>6 cm、低位受累或严重 ENE 则进入 N3。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "双侧颈部淋巴结转移，均 ≤6 cm，位于环状软骨尾侧缘以上，且无严重颈部 ENE", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-41535ba4bc7b5224a6ddfc8b", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，N3 的定义最符合下列哪项表述？", "options": {"A": "双侧颈部淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，无严重颈部包膜外侵", "B": "任一 VB 区淋巴结转移，即使≤6 cm且无严重包膜外侵", "C": "单侧或双侧颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下，或存在严重颈部包膜外侵", "D": "任何坏死性颈部淋巴结转移，即使≤6 cm且位于环状软骨以上"}, "answer": "C", "choices": ["A. 双侧颈部淋巴结转移，均≤6 cm，位于环状软骨尾侧缘以上，无严重颈部包膜外侵", "B. 任一 VB 区淋巴结转移，即使≤6 cm且无严重包膜外侵", "C. 单侧或双侧颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下，或存在严重颈部包膜外侵", "D. 任何坏死性颈部淋巴结转移，即使≤6 cm且位于环状软骨以上"], "explanation": "第9版新增了一个非常关键的点：严重颈部包膜外侵可直接触发 N3。除这一更新外，传统的 >6 cm 和尾侧缘以下标准仍然保留；单纯坏死或 VB 区受累并不是独立的 N3 定义。", "source": "CSCO 2025 第2.3节分期（页15注释）；AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 第2.3节分期（页15注释）", "AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）"], "answer_text": "单侧或双侧颈部淋巴结 >6 cm，或侵犯环状软骨尾侧缘以下，或存在严重颈部包膜外侵", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-ea53f9663b84038af3a6a0c8", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，严重颈部淋巴结包膜外侵在分期中的意义是？", "options": {"A": "一旦出现即按M1处理", "B": "主要用于T分期调整而非N分期调整", "C": "仅提示预后不良，但不影响N分期", "D": "可将原本N1–2级别的颈部结节病变升级至N3"}, "answer": "D", "choices": ["A. 一旦出现即按M1处理", "B. 主要用于T分期调整而非N分期调整", "C. 仅提示预后不良，但不影响N分期", "D. 可将原本N1–2级别的颈部结节病变升级至N3"], "explanation": "最新版分期把严重颈部淋巴结包膜外侵纳入N3，这是第九版分期的重要更新之一。它不只是预后因素，而是正式影响N分期。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "可将原本N1–2级别的颈部结节病变升级至N3", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-d3a03d9c5e6540da575a6add", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，关于咽后淋巴结严重包膜外侵，以下哪项最符合指南表述？", "options": {"A": "应与严重颈部ENE完全等同，一律直接按N3处理", "B": "不建议仅凭咽后淋巴结包膜情况直接升级至N3", "C": "一旦存在即归入M1a", "D": "一旦存在即按T4处理"}, "answer": "B", "choices": ["A. 应与严重颈部ENE完全等同，一律直接按N3处理", "B. 不建议仅凭咽后淋巴结包膜情况直接升级至N3", "C. 一旦存在即归入M1a", "D. 一旦存在即按T4处理"], "explanation": "最新版并不建议仅凭咽后淋巴结包膜情况把患者直接升级为N3。这里要避免把“严重颈部ENE”与“咽后结节异常”机械等同。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "不建议仅凭咽后淋巴结包膜情况直接升级至N3", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-4ef94d5d4b04ad25d7e3d0b0", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，T0 的定义是？", "options": {"A": "原位癌局限于鼻咽黏膜", "B": "局限鼻咽的微小灶，影像学难以显示", "C": "原发灶无法评价，但已有颈部淋巴结肿大", "D": "无原发肿瘤证据，但有EBV阳性的颈部淋巴结累及"}, "answer": "D", "choices": ["A. 原位癌局限于鼻咽黏膜", "B. 局限鼻咽的微小灶，影像学难以显示", "C. 原发灶无法评价，但已有颈部淋巴结肿大", "D. 无原发肿瘤证据，但有EBV阳性的颈部淋巴结累及"], "explanation": "T0指没有原发肿瘤证据，但存在EBV阳性的颈部淋巴结累及。它不是“原发灶无法评价”，也不是“原位癌”或“极小原发灶”。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "无原发肿瘤证据，但有EBV阳性的颈部淋巴结累及", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-4ed1cd98f95e34f52077aa58", "question": "单侧颈II区淋巴结 4.5 cm，MRI示侵犯胸锁乳突肌。分期中，该淋巴结最关键的分期意义是？", "options": {"A": "仍属N1，因为未超过6 cm", "B": "直接归为M1a", "C": "仍属N2，因为没有下颈受累", "D": "可按N3，因为存在严重颈部包膜外侵"}, "answer": "D", "choices": ["A. 仍属N1，因为未超过6 cm", "B. 直接归为M1a", "C. 仍属N2，因为没有下颈受累", "D. 可按N3，因为存在严重颈部包膜外侵"], "explanation": "严重颈部淋巴结包膜外侵（侵犯肌肉、皮肤、神经血管束等）已被纳入N3条件，不必等到>6 cm或下颈受累才升级。", "source": "CSCO 2025 §2.1–2.2；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1–2.2", "NCCN 2025 NASO-1 Workup"], "answer_text": "可按N3，因为存在严重颈部包膜外侵", "domain": "分期与风险分层", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-817f81d09fa650add2470d81", "question": "根据 CSCO 2025，以下哪项属于分期调整中写明的新要点？", "options": {"A": "任何咽后淋巴结高级别包膜外侵均直接升级至 N3", "B": "严重颈部淋巴结包膜外侵升级至 N3", "C": "M1a 与 M1b 以是否肝转移为界", "D": "T1N0 改归 IB 期"}, "answer": "B", "choices": ["A. 任何咽后淋巴结高级别包膜外侵均直接升级至 N3", "B. 严重颈部淋巴结包膜外侵升级至 N3", "C. M1a 与 M1b 以是否肝转移为界", "D. T1N0 改归 IB 期"], "explanation": "2025版将严重颈部淋巴结包膜外侵（侵犯皮肤、肌肉、神经血管束等）上调为 N3；咽后淋巴结高级别包膜外侵不建议仅凭此直接升 N3。", "source": "CSCO 2025 §2.3 分期【总分期表与注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【总分期表与注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "严重颈部淋巴结包膜外侵升级至 N3", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-795f18d16c54a7a961dc142b", "question": "根据 CSCO 2025，对于咽后淋巴结的高级别包膜外侵犯，下列哪项最符合分期与影像解释？", "options": {"A": "一律按 M1a 处理", "B": "一律直接按 N3 处理", "C": "一律按 T4 处理", "D": "一般不建议仅凭咽后淋巴结高级别包膜外侵犯升级至 N3"}, "answer": "D", "choices": ["A. 一律按 M1a 处理", "B. 一律直接按 N3 处理", "C. 一律按 T4 处理", "D. 一般不建议仅凭咽后淋巴结高级别包膜外侵犯升级至 N3"], "explanation": "最新版分期注释强调：咽后淋巴结高级别包膜外侵犯患者预后优于 N3，不建议仅凭这一点直接升级 N3。", "source": "CSCO 2025 §2.3 分期注释（包膜外侵/N分期）；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期注释（包膜外侵/N分期）", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "一般不建议仅凭咽后淋巴结高级别包膜外侵犯升级至 N3", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-B. N分期、ENE与淋巴结风险"} |
| {"id": "l1-sample-ca17666d22625293321f962e", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，M1a 指？", "options": {"A": "≥1个器官/部位存在≤3个转移病灶", "B": "单器官转移但病灶数>3个", "C": "仅远处淋巴结转移而无实质器官转移", "D": "仅单器官单病灶转移"}, "answer": "A", "choices": ["A. ≥1个器官/部位存在≤3个转移病灶", "B. 单器官转移但病灶数>3个", "C. 仅远处淋巴结转移而无实质器官转移", "D. 仅单器官单病灶转移"], "explanation": "M1a指≥1个器官/部位存在≤3个转移病灶。新版分期不是按“器官类型”或“是否单器官”来分，而是按转移灶总数分层。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "≥1个器官/部位存在≤3个转移病灶", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-a426bf344df0e58a02e4320f", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，M1b 指？", "options": {"A": "仅骨转移且骨灶>3个时才属M1b", "B": "仅肺转移", "C": "≥1个器官/部位存在>3个转移病灶", "D": "任何肝转移均属M1b"}, "answer": "C", "choices": ["A. 仅骨转移且骨灶>3个时才属M1b", "B. 仅肺转移", "C. ≥1个器官/部位存在>3个转移病灶", "D. 任何肝转移均属M1b"], "explanation": "M1b指≥1个器官/部位存在>3个转移病灶。它不是按特定器官来定义，也不限于骨或肺。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "≥1个器官/部位存在>3个转移病灶", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-75cebc344564c7fb52ad8a8d", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，IA 期最符合分期表述的是：", "options": {"A": "T4N0–2M0或任何T、N3M0", "B": "T1–2N0M0", "C": "T3N0–2M0", "D": "T0–2N1M0"}, "answer": "B", "choices": ["A. T4N0–2M0或任何T、N3M0", "B. T1–2N0M0", "C. T3N0–2M0", "D. T0–2N1M0"], "explanation": "IA期为T1–2N0M0。最新版把T1N0与T2N0合并为IA，是第九版鼻咽癌分期的重要变化。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "T1–2N0M0", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-40b33d025527c63becbf74d2", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪一组属于 ⅠB 期？", "options": {"A": "T1–2N0M0", "B": "T3N0–2M0", "C": "T0–2N1M0", "D": "T4N0–2M0 或任何 T、N3M0"}, "answer": "C", "choices": ["A. T1–2N0M0", "B. T3N0–2M0", "C. T0–2N1M0", "D. T4N0–2M0 或任何 T、N3M0"], "explanation": "第9版将 T0–2N1M0 归入 ⅠB 期，这也是这版总分期最容易被沿用旧习惯误判的地方之一。T1–2N0M0 属于 ⅠA 期；T3N0–2M0 属于 Ⅱ期；T4N0–2M0 或任何 T、N3M0 属于 Ⅲ期。", "source": "CSCO 2025 第2.3节分期（页15注释与总分期表）；AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 第2.3节分期（页15注释与总分期表）", "AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）"], "answer_text": "T0–2N1M0", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-2f35aa16c3b165b16ad7e167", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，II 期最符合分期表述的是：", "options": {"A": "T0–2N2M0或T3N0–2M0", "B": "T1–2N0–1M0", "C": "任何T、任何N、M1a", "D": "T4N0–2M0或任何T、N3M0"}, "answer": "A", "choices": ["A. T0–2N2M0或T3N0–2M0", "B. T1–2N0–1M0", "C. 任何T、任何N、M1a", "D. T4N0–2M0或任何T、N3M0"], "explanation": "II期核心覆盖T0–2N2M0或T3N0–2M0。也就是说，原来部分更高期别患者在第九版中被下调到了II期。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "T0–2N2M0或T3N0–2M0", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-de28257eedb482ffb44d1cca", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，下列哪一组属于 Ⅲ期？", "options": {"A": "T3N1M0", "B": "T1–2N0M0", "C": "任何 T、任何 N、M1a", "D": "T4N0–2M0，或任何 T、N3M0"}, "answer": "D", "choices": ["A. T3N1M0", "B. T1–2N0M0", "C. 任何 T、任何 N、M1a", "D. T4N0–2M0，或任何 T、N3M0"], "explanation": "第9版中，Ⅲ期由两大类构成：T4N0–2M0，以及任何 T、N3M0。T3N1M0 已下调至 Ⅱ期；T1–2N0M0 属于 ⅠA 期；M1a 则进入转移性分组。", "source": "CSCO 2025 第2.3节分期（页15注释与总分期表）；AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 第2.3节分期（页15注释与总分期表）", "AJCC/UICC 第9版 NPC TNM 分期（Pan et al., JAMA Oncol 2024）"], "answer_text": "T4N0–2M0，或任何 T、N3M0", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-06d91d044e80a719c3e16a5b", "question": "根据 AJCC/UICC 第9版与 CSCO 2025，关于鼻咽癌总体分期框架，下列哪项正确？", "options": {"A": "Stage IV 仍包括大量非转移性 T4/N3 病例", "B": "所有 T4M0 仍自动归入 Stage IV", "C": "所有 N3M0 仍自动归入 IVA", "D": "Stage IV 仅保留给 M1 疾病，并细分为 IVA（M1a）和 IVB（M1b）"}, "answer": "D", "choices": ["A. Stage IV 仍包括大量非转移性 T4/N3 病例", "B. 所有 T4M0 仍自动归入 Stage IV", "C. 所有 N3M0 仍自动归入 IVA", "D. Stage IV 仅保留给 M1 疾病，并细分为 IVA（M1a）和 IVB（M1b）"], "explanation": "最新版 AJCC/UICC 第 9 版 NPC 分期将 Stage IV 限定为 M1 疾病，并进一步细分为 IVA（M1a）和 IVB（M1b）。因此非转移性的 T4M0 或 N3M0 不再归入 Stage IV，这是与旧版最容易混淆的关键变化之一。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "Stage IV 仅保留给 M1 疾病，并细分为 IVA（M1a）和 IVB（M1b）", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-0c9d35876d6a567eb01c71a6", "question": "患者分期为T2N1M0。按总体分期，最符合的是？", "options": {"A": "II期", "B": "IA期", "C": "IB期", "D": "III期"}, "answer": "C", "choices": ["A. II期", "B. IA期", "C. IB期", "D. III期"], "explanation": "最新版把T1–2N0合并为IA，把T0–2N1调整为IB，这是与旧版最容易混淆的点之一。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "IB期", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-5c40187fd1dfae0e04cda89b", "question": "患者cT4N2M1，PET/CT示肝和骨共4个远处病灶。按总体分期，最符合的是？", "options": {"A": "不能分期，需先治疗后再定", "B": "III期", "C": "IVA期", "D": "IVB期"}, "answer": "D", "choices": ["A. 不能分期，需先治疗后再定", "B. III期", "C. IVA期", "D. IVB期"], "explanation": "最新版NPC把Stage IV限定为M1，并按转移灶总数分为IVA（M1a，≤3灶）和IVB（M1b，>3灶）。本例4个远处病灶，故为IVB。", "source": "CSCO 2025 §2.3 分期【总分期表与注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【总分期表与注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "IVB期", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-c8a1c14ebfa64227afd33e9e", "question": "根据 CSCO 2025，鼻咽癌总体分期中，哪项最符合 2025 的新分期框架？", "options": {"A": "Stage IV 仅保留给转移性疾病，并细分 IVA/IVB", "B": "Stage IV 仍包含大量非转移性 T4/N3 患者", "C": "M1 不再细分", "D": "T1N0 与 T2N0 仍分属不同总分期"}, "answer": "A", "choices": ["A. Stage IV 仅保留给转移性疾病，并细分 IVA/IVB", "B. Stage IV 仍包含大量非转移性 T4/N3 患者", "C. M1 不再细分", "D. T1N0 与 T2N0 仍分属不同总分期"], "explanation": "2025版采用 AJCC/UICC 第九版逻辑：将初诊转移性鼻咽癌统归 IV 期，并按转移灶个数分为 IVA（M1a）和 IVB（M1b）。", "source": "CSCO 2025 §2.3 分期【总分期表与注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【总分期表与注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "Stage IV 仅保留给转移性疾病，并细分 IVA/IVB", "domain": "分期与风险分层", "source_type": "CSCO-only", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-4fd242c96e36d2ca25f29456", "question": "根据 CSCO 2025，对于鼻咽坏死患者，特别指出哪一因素可纳入临床风险分层模型？", "options": {"A": "既往是否扁桃体切除", "B": "ABO 血型", "C": "颈内动脉暴露情况", "D": "是否近视"}, "answer": "C", "choices": ["A. 既往是否扁桃体切除", "B. ABO 血型", "C. 颈内动脉暴露情况", "D. 是否近视"], "explanation": "CSCO 2025 指出鼻咽坏死的风险分层模型可结合放疗疗程数和颈内动脉暴露情况，用于预后判断和外科决策。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗；NCCN 2025 ADV-3/ADV-A", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗", "NCCN 2025 ADV-3/ADV-A"], "answer_text": "颈内动脉暴露情况", "domain": "分期与风险分层", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "II. 分期与风险分层", "scope_minor": "II-C. 总体分期与综合风险分层"} |
| {"id": "l1-sample-2e52e74d44341d386ee62bb9", "question": "根据 CSCO 2025，T1N0 的标准初治结论是？", "options": {"A": "必须诱导化疗", "B": "无须化疗，根治性放疗为主", "C": "必须辅助化疗", "D": "必须同步化疗"}, "answer": "B", "choices": ["A. 必须诱导化疗", "B. 无须化疗，根治性放疗为主", "C. 必须辅助化疗", "D. 必须同步化疗"], "explanation": "CSCO下T1N0标准初治结论是无须化疗，治疗核心是根治性放疗。给这类低期患者常规加化疗属于过度治疗。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "无须化疗，根治性放疗为主", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-9d8d869a18f96be5cd6ee230", "question": "根据 NCCN 2025，T1N0M0 的标准局部治疗是？", "options": {"A": "免疫联合 RT", "B": "CCRT→辅助", "C": "definitive RT", "D": "IC→CCRT"}, "answer": "C", "choices": ["A. 免疫联合 RT", "B. CCRT→辅助", "C. definitive RT", "D. IC→CCRT"], "explanation": "NCCN对T1N0M0同样给出definitive RT为标准局部治疗。题目用NCCN是为了和CSCO形成一致、互相印证的主干知识点。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "definitive RT", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-bd5b265fbf404509ffbe297f", "question": "根据 NCCN 2025，T2N0M0 若存在 high-risk features，更符合的是？", "options": {"A": "definitive RT ± concurrent systemic therapy", "B": "必须手术", "C": "仍只能 RT alone", "D": "必须后线免疫"}, "answer": "A", "choices": ["A. definitive RT ± concurrent systemic therapy", "B. 必须手术", "C. 仍只能 RT alone", "D. 必须后线免疫"], "explanation": "NCCN对T2N0M0若存在high-risk features，可在definitive RT基础上加同期系统治疗。也就是说，NCCN在这类患者上保留了‘RT±并放’的风险分层。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "definitive RT ± concurrent systemic therapy", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-48a9ff5ed5f2b1b5c5130463", "question": "根据 CSCO 2025，T1–2N1 一旦合并明显不良因素，更标准的路径是哪一项？", "options": {"A": "仍优先单纯放疗，不因危险因素改变", "B": "同期放化疗", "C": "先完成放疗，再视情况只做辅助治疗", "D": "必须一律升级为诱导化疗后同期放化疗"}, "answer": "B", "choices": ["A. 仍优先单纯放疗，不因危险因素改变", "B. 同期放化疗", "C. 先完成放疗，再视情况只做辅助治疗", "D. 必须一律升级为诱导化疗后同期放化疗"], "explanation": "一旦 T1–2N1 合并高 EBV DNA、较大淋巴结、Ⅳ/ⅤB 区受累或包膜外侵等不良因素，CSCO 更标准的路径是同期放化疗。这里要区分“可降阶的低危 N1”和“需要升级的非低危 N1”。", "source": "CSCO 2025 表10（T1–2N1 分层推荐）+ 表11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 表10（T1–2N1 分层推荐）+ 表11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "同期放化疗", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-81eed36698570de1a046ee47", "question": "根据 CSCO 2025，T4N0 或 T3N1 的 I 级推荐是？", "options": {"A": "仅辅助化疗", "B": "单纯放疗", "C": "单药免疫", "D": "诱导化疗 + 同期放化疗"}, "answer": "D", "choices": ["A. 仅辅助化疗", "B. 单纯放疗", "C. 单药免疫", "D. 诱导化疗 + 同期放化疗"], "explanation": "T4N0或T3N1属于更高风险局晚期，CSCO的I级推荐是诱导化疗+同期放化疗。这里考的是与T3N0、T1–2N1等边界分层的区别。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "诱导化疗 + 同期放化疗", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-cf54cf1c2ee4e3bf5d39ffd0", "question": "根据 CSCO 2025，T1–4N2–3 和 T4N1 的高等级推荐包括？", "options": {"A": "仅诱导化疗 + 同期放化疗", "B": "仅诱导化疗 + 同期放化疗 + 节拍辅助化疗", "C": "诱导化疗 + 同期放化疗，以及诱导化疗 + 同期放化疗 + 节拍辅助化疗", "D": "单纯放疗"}, "answer": "C", "choices": ["A. 仅诱导化疗 + 同期放化疗", "B. 仅诱导化疗 + 同期放化疗 + 节拍辅助化疗", "C. 诱导化疗 + 同期放化疗，以及诱导化疗 + 同期放化疗 + 节拍辅助化疗", "D. 单纯放疗"], "explanation": "CSCO 2025 表10对 T1–4N2–3 和 T4N1 的Ⅰ级推荐同时包括两条路径：IC+CCRT，以及 IC+CCRT+节拍辅助化疗。单纯放疗不属于这一分层的高等级推荐。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "诱导化疗 + 同期放化疗，以及诱导化疗 + 同期放化疗 + 节拍辅助化疗", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-15b7083085b8ee660e03e802", "question": "根据 CSCO 2025，T1–4N2–3 和 T4N1 中，已进入高等级推荐的免疫整合路径更接近？", "options": {"A": "先手术后 PD-1", "B": "IC + CCRT + PD-1", "C": "RT + PD-1 单药", "D": "后线进展后才加 PD-1"}, "answer": "B", "choices": ["A. 先手术后 PD-1", "B. IC + CCRT + PD-1", "C. RT + PD-1 单药", "D. 后线进展后才加 PD-1"], "explanation": "在CSCO里，T1–4N2–3和T4N1已进入高等级推荐的免疫整合路径更接近IC+CCRT+PD-1，而不是单纯RT加PD-1或手术后用PD-1。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "IC + CCRT + PD-1", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-44af6bb31c0a5f0a25e736eb", "question": "根据 CSCO 2025 表10，对 T3N0 且无高危不良预后因素的患者，最符合表格的分层推荐是：", "options": {"A": "单纯放疗可作为 1A类选择；同期放化疗为 2A类", "B": "只能辅助化疗", "C": "必须同期放化疗 + 特瑞普利单抗", "D": "必须诱导化疗 + 同期放化疗（1A类）"}, "answer": "A", "choices": ["A. 单纯放疗可作为 1A类选择；同期放化疗为 2A类", "B. 只能辅助化疗", "C. 必须同期放化疗 + 特瑞普利单抗", "D. 必须诱导化疗 + 同期放化疗（1A类）"], "explanation": "2025 CSCO 表10中，T3N0 的写法是：同期放化疗（2A类）；若无 EBV DNA≥4000 copies/ml、肿瘤体积大等不良预后因素，单纯放疗可列为 1A类选择。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "单纯放疗可作为 1A类选择；同期放化疗为 2A类", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-A. 早/中期与降阶场景"} |
| {"id": "l1-sample-50abd9294da917801d2cf2d7", "question": "根据 NCCN 2025，局部晚期鼻咽癌诱导/序贯治疗的 preferred regimens 包括哪一项？", "options": {"A": "GP 与 dose-adjusted TPF", "B": "PF 与 MTX", "C": "cetuximab 单药与 nivolumab 单药", "D": "paclitaxel 单药与顺铂单药"}, "answer": "A", "choices": ["A. GP 与 dose-adjusted TPF", "B. PF 与 MTX", "C. cetuximab 单药与 nivolumab 单药", "D. paclitaxel 单药与顺铂单药"], "explanation": "NCCN 2025 在 NASO-B 中把 gemcitabine/cisplatin 和 dose-adjusted TPF 列为 induction/sequential systemic therapy 的 preferred regimens。PF 属于 other recommended；其余选项不在该层级内。", "source": "NCCN 2025 NASO-B 1/3（Induction/Sequential Systemic Therapy, Preferred Regimens）；CSCO 2025 表11", "evidence_anchors": ["NCCN 2025 NASO-B 1/3（Induction/Sequential Systemic Therapy, Preferred Regimens）", "CSCO 2025 表11"], "answer_text": "GP 与 dose-adjusted TPF", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-339ee3b6727d5a71b3e97ee1", "question": "根据 NCCN 2025，鼻咽癌诱导治疗 other recommended regimens 包括？", "options": {"A": "Nivolumab/ipilimumab", "B": "Cisplatin/5-FU 与 docetaxel/cisplatin", "C": "Methotrexate 单药", "D": "Tislelizumab 单药"}, "answer": "B", "choices": ["A. Nivolumab/ipilimumab", "B. Cisplatin/5-FU 与 docetaxel/cisplatin", "C. Methotrexate 单药", "D. Tislelizumab 单药"], "explanation": "NCCN把cisplatin/5-FU和docetaxel/cisplatin放在鼻咽癌诱导治疗的other recommended regimens里。免疫单药或MTX并不属于这里的诱导方案。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "Cisplatin/5-FU 与 docetaxel/cisplatin", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-bd2cc2ca133547663da668e2", "question": "根据 CSCO 2025，关于局部晚期鼻咽癌诱导化疗的推荐等级，以下哪项表述最准确？", "options": {"A": "只有GP属于I级推荐，TPF和TP均降为2A类", "B": "单药吉西他滨因耐受性好而被列为I级推荐", "C": "GP和TPF属于I级推荐，TP为2A类，而单药吉西他滨不属高等级诱导方案", "D": "只要含顺铂的两药或三药方案均自动属于I级推荐"}, "answer": "C", "choices": ["A. 只有GP属于I级推荐，TPF和TP均降为2A类", "B. 单药吉西他滨因耐受性好而被列为I级推荐", "C. GP和TPF属于I级推荐，TP为2A类，而单药吉西他滨不属高等级诱导方案", "D. 只要含顺铂的两药或三药方案均自动属于I级推荐"], "explanation": "CSCO对局晚期NPC诱导治疗的高等级方案主要集中在GP和TPF等成熟多药含铂方案；TP通常位于较低层级，而单药吉西他滨并非该处置框架中的高等级诱导方案。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "GP和TPF属于I级推荐，TP为2A类，而单药吉西他滨不属高等级诱导方案", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-912a1fae2624e18bf8f705a2", "question": "根据 CSCO 2025，下列哪项属于诱导化疗 2A类方案？", "options": {"A": "cetuximab + RT", "B": "单药卡培他滨", "C": "单药顺铂", "D": "TP"}, "answer": "D", "choices": ["A. cetuximab + RT", "B. 单药卡培他滨", "C. 单药顺铂", "D. TP"], "explanation": "在CSCO中，TP可作为诱导化疗2A类方案之一。它不是I级首选，但也不是完全不推荐。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "TP", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-69c28a1bb9fa9293003e7665", "question": "根据 CSCO 2025，同期化疗 1A类方案是？", "options": {"A": "派安普利单抗", "B": "顺铂", "C": "卡瑞利珠单抗", "D": "西妥昔单抗"}, "answer": "B", "choices": ["A. 派安普利单抗", "B. 顺铂", "C. 卡瑞利珠单抗", "D. 西妥昔单抗"], "explanation": "CSCO同期化疗1A类核心药物是顺铂。免疫药和EGFR单抗不在这一条目的核心同步化疗定义里。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "顺铂", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-7bd0ee2115383a7e284f67ff", "question": "根据 NCCN 2025，induction 之后，与 RT 同期的药物通常包括？", "options": {"A": "MTX 单药", "B": "pembrolizumab 单药", "C": "weekly 5-FU", "D": "weekly cisplatin 或 carboplatin"}, "answer": "D", "choices": ["A. MTX 单药", "B. pembrolizumab 单药", "C. weekly 5-FU", "D. weekly cisplatin 或 carboplatin"], "explanation": "NCCN写得很明确：induction后与RT同期的药物通常包括weekly cisplatin或carboplatin。题目考的是‘诱导后并放常用药’这个表格细节。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "weekly cisplatin 或 carboplatin", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-5dc3d56314aefba20c52e485", "question": "根据 NCCN 2025，CCRT 后辅助治疗的 preferred regimen 是？", "options": {"A": "RT 后接 nivolumab", "B": "RT 后接 cetuximab", "C": "RT 后接 docetaxel", "D": "Cisplatin + RT 后接 cisplatin/5-FU"}, "answer": "D", "choices": ["A. RT 后接 nivolumab", "B. RT 后接 cetuximab", "C. RT 后接 docetaxel", "D. Cisplatin + RT 后接 cisplatin/5-FU"], "explanation": "NCCN对CCRT后辅助治疗的preferred regimen是cisplatin + RT followed by cisplatin/5-FU。carboplatin/5-FU是other recommended替代方案。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "Cisplatin + RT 后接 cisplatin/5-FU", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-c2a1fb7957e15eba388451f9", "question": "根据 CSCO 2025，局部晚期鼻咽癌辅助治疗 1A类包括？", "options": {"A": "单药 docetaxel", "B": "单药 cetuximab", "C": "单药派安普利单抗", "D": "节拍卡培他滨"}, "answer": "D", "choices": ["A. 单药 docetaxel", "B. 单药 cetuximab", "C. 单药派安普利单抗", "D. 节拍卡培他滨"], "explanation": "CSCO局晚期辅助治疗1A类包括节拍卡培他滨和顺铂+5-FU两条经典路径。题目用分开出题来提高覆盖与干扰强度。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "节拍卡培他滨", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-cca479f644bef3c252a30c26", "question": "58岁患者，cT3N2M0，ECOG 0。按NCCN，最符合指南层级的治疗描述是？", "options": {"A": "临床试验或IC→CCRT（preferred，category 1）或CCRT→adjuvant", "B": "RT alone", "C": "手术优先", "D": "单药pembrolizumab"}, "answer": "A", "choices": ["A. 临床试验或IC→CCRT（preferred，category 1）或CCRT→adjuvant", "B. RT alone", "C. 手术优先", "D. 单药pembrolizumab"], "explanation": "T3N1–3/T4N0–3/T0(EBV+)–2N2–3属于NCCN更高危局晚期组，clinical trial优先，IC→CCRT为preferred category 1，也可CCRT后接辅助化疗。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "临床试验或IC→CCRT（preferred，category 1）或CCRT→adjuvant", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-c77187029adfcd2b2655bb36", "question": "同步放化疗阶段患者出现顺铂绝对禁忌，题干要求选择‘CSCO已明确列为可考虑的替代同步药物’。以下哪项最不符合要求？", "options": {"A": "Carboplatin AUC 5–6", "B": "Pemetrexed 500 mg/m² q3w", "C": "Oxaliplatin 70 mg/m² weekly", "D": "Nedaplatin 100 mg/m² q3w"}, "answer": "B", "choices": ["A. Carboplatin AUC 5–6", "B. Pemetrexed 500 mg/m² q3w", "C. Oxaliplatin 70 mg/m² weekly", "D. Nedaplatin 100 mg/m² q3w"], "explanation": "CSCO正文列出的顺铂禁忌替代包括卡铂、奥沙利铂和奈达铂；培美曲塞不在鼻咽癌同步替代药物的这一组里。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "Pemetrexed 500 mg/m² q3w", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-d5c43867eb832ca556e0bdd1", "question": "根据 CSCO 2025，对无法使用顺铂的同期放化疗患者，可选的其他同期药物不包括：", "options": {"A": "奥沙利铂 70 mg/m² 每周一次", "B": "卡铂 AUC 5–6", "C": "伊匹木单抗 1 mg/kg 每 6 周一次", "D": "奈达铂 100 mg/m² 每 3 周一次"}, "answer": "C", "choices": ["A. 奥沙利铂 70 mg/m² 每周一次", "B. 卡铂 AUC 5–6", "C. 伊匹木单抗 1 mg/kg 每 6 周一次", "D. 奈达铂 100 mg/m² 每 3 周一次"], "explanation": "CSCO 对顺铂禁忌/不耐受患者给出的同期替代包括卡铂、奥沙利铂和奈达铂，不包括 CTLA-4 单抗伊匹木单抗。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "伊匹木单抗 1 mg/kg 每 6 周一次", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-39a167da1f0936ecf8c01a2e", "question": "根据 CSCO 2025，关于局部晚期鼻咽癌同期顺铂给药方式，更强调：", "options": {"A": "累积剂量不重要，只要完成 1 个周期即可", "B": "3周方案绝对优于每周方案", "C": "每周方案绝对优于3周方案", "D": "决定疗效更关键的是顺铂累积剂量，而不是给药频次本身"}, "answer": "D", "choices": ["A. 累积剂量不重要，只要完成 1 个周期即可", "B. 3周方案绝对优于每周方案", "C. 每周方案绝对优于3周方案", "D. 决定疗效更关键的是顺铂累积剂量，而不是给药频次本身"], "explanation": "2025版明确指出，现有证据更提示顺铂累积剂量较给药频次更关键，累积剂量通常不应低于 200 mg/m²。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "决定疗效更关键的是顺铂累积剂量，而不是给药频次本身", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-7a6902544497c8c940e92f80", "question": "根据 CSCO 2025，关于同期顺铂累积剂量，更符合指南的说法是：", "options": {"A": "不应低于 150 mg/m²", "B": "不应低于 200 mg/m²", "C": "不应低于 100 mg/m²", "D": "不应低于 300 mg/m²"}, "answer": "B", "choices": ["A. 不应低于 150 mg/m²", "B. 不应低于 200 mg/m²", "C. 不应低于 100 mg/m²", "D. 不应低于 300 mg/m²"], "explanation": "CSCO 2025 在局部晚期药物治疗章节明确指出，一些Ⅲ期试验探索性分析提示顺铂累积剂量不应低于 200 mg/m²。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "不应低于 200 mg/m²", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-2676b95fa55891e94043d0bb", "question": "根据 CSCO 2025，紫杉醇（或紫杉醇白蛋白）+ 顺铂 + 卡培他滨这一一线 1B类方案，最符合表格的特征是：", "options": {"A": "只能用于既往接受过PD-1治疗的患者", "B": "固定只做2疗程，不做任何维持", "C": "21天为一个疗程，化疗阶段后卡培他滨继续维持至疾病进展或不良反应不可耐受", "D": "必须同步放疗后才能用"}, "answer": "C", "choices": ["A. 只能用于既往接受过PD-1治疗的患者", "B. 固定只做2疗程，不做任何维持", "C. 21天为一个疗程，化疗阶段后卡培他滨继续维持至疾病进展或不良反应不可耐受", "D. 必须同步放疗后才能用"], "explanation": "CSCO 2025 表格写明：紫杉醇或紫杉醇白蛋白 + 顺铂 + 卡培他滨为1B类方案，化疗按21天一疗程，卡培他滨可持续维持至进展或不可耐受。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "21天为一个疗程，化疗阶段后卡培他滨继续维持至疾病进展或不良反应不可耐受", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-7246208d6956bf42c0902ab6", "question": "根据 CSCO 2025，顺铂 + 吉西他滨 + 恩度 这一 2B类方案，最符合表格的周期特征是：", "options": {"A": "21天一疗程，固定6疗程", "B": "14天一疗程，直到进展", "C": "21天一疗程，最多4疗程", "D": "28天一疗程，最多8疗程"}, "answer": "C", "choices": ["A. 21天一疗程，固定6疗程", "B. 14天一疗程，直到进展", "C. 21天一疗程，最多4疗程", "D. 28天一疗程，最多8疗程"], "explanation": "CSCO 表格中，顺铂+吉西他滨+恩度的写法为21天一疗程，最多4疗程。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "21天一疗程，最多4疗程", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-44909a8c2edc6f2ec7a40fb5", "question": "根据 CSCO 2025，关于局部晚期鼻咽癌诱导化疗表格，GP 与 TPF 的典型周期写法最符合的是：", "options": {"A": "GP 固定1疗程，TPF 固定6疗程", "B": "GP 为每周方案，TPF 为每2周方案", "C": "二者通常都按每3周一次，共3疗程书写", "D": "二者都按每4周一次，直到进展"}, "answer": "C", "choices": ["A. GP 固定1疗程，TPF 固定6疗程", "B. GP 为每周方案，TPF 为每2周方案", "C. 二者通常都按每3周一次，共3疗程书写", "D. 二者都按每4周一次，直到进展"], "explanation": "CSCO 2022–2025 对局部晚期诱导化疗注释均强调：GP 和 TPF 的关键随机试验通常按每3周一次、共3疗程进行。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表11；NCCN 2025 NASO-B（诱导/序贯系统治疗）", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表11", "NCCN 2025 NASO-B（诱导/序贯系统治疗）"], "answer_text": "二者通常都按每3周一次，共3疗程书写", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-3e859d722c6076e3f6c15745", "question": "根据 CSCO 2025 表10，对 T1-4N2-3 和 T4N1，以下哪项属于 1A类推荐？", "options": {"A": "仅免疫单药", "B": "仅同步顺铂单药", "C": "诱导化疗 + 同期放化疗；诱导化疗 + 同期放化疗 + 节拍辅助化疗；诱导化疗 + 同期放化疗 + 信迪利单抗/卡瑞利珠单抗", "D": "单纯放疗"}, "answer": "C", "choices": ["A. 仅免疫单药", "B. 仅同步顺铂单药", "C. 诱导化疗 + 同期放化疗；诱导化疗 + 同期放化疗 + 节拍辅助化疗；诱导化疗 + 同期放化疗 + 信迪利单抗/卡瑞利珠单抗", "D. 单纯放疗"], "explanation": "表10中 T1-4N2-3 和 T4N1 的 1A类包括 IC+CCRT、IC+CCRT+节拍辅助化疗、IC+CCRT+信迪利单抗/卡瑞利珠单抗。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "诱导化疗 + 同期放化疗；诱导化疗 + 同期放化疗 + 节拍辅助化疗；诱导化疗 + 同期放化疗 + 信迪利单抗/卡瑞利珠单抗", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-4a4088e3670aa78d2b98ca83", "question": "根据 CSCO 2025 表11，局部晚期鼻咽癌的诱导化疗 1A类方案不包括：", "options": {"A": "顺铂 + 5-FU", "B": "紫杉醇 + 顺铂 + 卡培他滨", "C": "TPF", "D": "GP"}, "answer": "A", "choices": ["A. 顺铂 + 5-FU", "B. 紫杉醇 + 顺铂 + 卡培他滨", "C. TPF", "D. GP"], "explanation": "表11中诱导化疗 1A类为 TPF、GP、紫杉醇+顺铂+卡培他滨；顺铂+5-FU 被列为 1B类。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "顺铂 + 5-FU", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-d10a282c5e323002e54c1fa0", "question": "根据 CSCO 2025 表11，下列哪项最符合局部晚期鼻咽癌辅助化疗在表格中的推荐层级？", "options": {"A": "只有顺铂+5-FU 为 1A类，节拍卡培他滨为 2A类", "B": "节拍卡培他滨与顺铂+5-FU 均为 1A类", "C": "卡培他滨单药为 1A类，但节拍卡培他滨不是", "D": "所有辅助化疗都只列为 2B类"}, "answer": "B", "choices": ["A. 只有顺铂+5-FU 为 1A类，节拍卡培他滨为 2A类", "B. 节拍卡培他滨与顺铂+5-FU 均为 1A类", "C. 卡培他滨单药为 1A类，但节拍卡培他滨不是", "D. 所有辅助化疗都只列为 2B类"], "explanation": "表11显示辅助化疗中，节拍卡培他滨和顺铂+5-FU均列为 1A类；顺铂+卡培他滨、卡培他滨列为较低等级。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "节拍卡培他滨与顺铂+5-FU 均为 1A类", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-b42155d77451872297e59d46", "question": "根据 NCCN 2025 NASO-B 脚注，关于“cisplatin + RT 不接辅助化疗”的证据等级，下列哪项最准确？", "options": {"A": "对 T3,N1–3,M0 / T4,N0–3,M0 / T0(EBV+)–2,N2–3,M0 为 category 2B；对其他适应分期为 category 2A", "B": "对所有需并放的分期均为 category 1", "C": "所有分期都只列为 category 2B", "D": "NCCN 不区分不同分期的证据等级"}, "answer": "A", "choices": ["A. 对 T3,N1–3,M0 / T4,N0–3,M0 / T0(EBV+)–2,N2–3,M0 为 category 2B；对其他适应分期为 category 2A", "B. 对所有需并放的分期均为 category 1", "C. 所有分期都只列为 category 2B", "D. NCCN 不区分不同分期的证据等级"], "explanation": "NCCN NASO-B 脚注 c 明确区分了 cisplatin + RT without adjuvant chemotherapy 的 2B 与 2A 适用分期。", "source": "NCCN 2025 NASO-B（cisplatin + RT without adjuvant chemotherapy 证据等级脚注）", "evidence_anchors": ["NCCN 2025 NASO-B（cisplatin + RT without adjuvant chemotherapy 证据等级脚注）"], "answer_text": "对 T3,N1–3,M0 / T4,N0–3,M0 / T0(EBV+)–2,N2–3,M0 为 category 2B；对其他适应分期为 category 2A", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-B. 局部晚期标准路径"} |
| {"id": "l1-sample-02e087c0de8e4a3805be721f", "question": "根据 CSCO 2025，对顺铂绝对禁忌、但仍需完成同期治疗的患者，以下哪组药物全部属于指南已明确列出的替代同步方案？", "options": {"A": "卡铂 AUC 5、吉西他滨 1000 mg/m²、依托泊苷 100 mg/m²", "B": "奥沙利铂 85 mg/m² q2w、培美曲塞、替吉奥", "C": "卡铂 AUC 5–6、奥沙利铂 70 mg/m² weekly、奈达铂 100 mg/m² q3w", "D": "卡铂 AUC 2 weekly、培美曲塞 500 mg/m²、奈达铂 80 mg/m²"}, "answer": "C", "choices": ["A. 卡铂 AUC 5、吉西他滨 1000 mg/m²、依托泊苷 100 mg/m²", "B. 奥沙利铂 85 mg/m² q2w、培美曲塞、替吉奥", "C. 卡铂 AUC 5–6、奥沙利铂 70 mg/m² weekly、奈达铂 100 mg/m² q3w", "D. 卡铂 AUC 2 weekly、培美曲塞 500 mg/m²、奈达铂 80 mg/m²"], "explanation": "CSCO正文明确列出顺铂禁忌时可考虑的同期替代药物为：卡铂AUC 5–6、奥沙利铂70 mg/m²每周一次、奈达铂100 mg/m²每3周一次。其余选项要么剂量不符，要么药物本身不在该替代清单内。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "卡铂 AUC 5–6、奥沙利铂 70 mg/m² weekly、奈达铂 100 mg/m² q3w", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-C. 同期药物、给药方式与禁忌"} |
| {"id": "l1-sample-2ea018100cb468ab13fbba6a", "question": "根据 CSCO 2025，周疗与三周疗顺铂的比较，当前更稳妥的表述是：", "options": {"A": "累积剂量更关键，通常不应低于 200 mg/m²", "B": "两者都不再推荐", "C": "三周疗一定优于周疗", "D": "周疗一定优于三周疗"}, "answer": "A", "choices": ["A. 累积剂量更关键，通常不应低于 200 mg/m²", "B. 两者都不再推荐", "C. 三周疗一定优于周疗", "D. 周疗一定优于三周疗"], "explanation": "当前更稳妥的表述不是周疗一定优于三周疗，或反之，而是顺铂累计剂量更关键。CSCO强调总累积剂量通常不应低于200 mg/m²。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "累积剂量更关键，通常不应低于 200 mg/m²", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-C. 同期药物、给药方式与禁忌"} |
| {"id": "l1-sample-05e59e7b0819e1c1ea30014d", "question": "根据 NCCN 2025，classic concurrent systemic therapy/RT 中，q3w 顺铂一般给？", "options": {"A": "25 mg/m² d1–4", "B": "100 mg/m²，共 2–3 周期", "C": "40 mg/m²，共 2 周期", "D": "80 mg 固定剂量每周"}, "answer": "B", "choices": ["A. 25 mg/m² d1–4", "B. 100 mg/m²，共 2–3 周期", "C. 40 mg/m²，共 2 周期", "D. 80 mg 固定剂量每周"], "explanation": "NCCN常见的classic concurrent systemic therapy/RT写法是70 Gy左右常规分割RT联合顺铂100 mg/m² q3w，给2–3周期。不是每天低剂量连续给药的写法。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "100 mg/m²，共 2–3 周期", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-C. 同期药物、给药方式与禁忌"} |
| {"id": "l1-sample-e22d7b5a179330f94162b752", "question": "根据 NCCN 2025，对 cisplatin ineligible/intolerant 者，可考虑？", "options": {"A": "只能改用 EGFR 单抗", "B": "Carboplatin + RT followed by carboplatin/5-FU", "C": "直接放弃同期治疗", "D": "只能改用 PD-1 单药"}, "answer": "B", "choices": ["A. 只能改用 EGFR 单抗", "B. Carboplatin + RT followed by carboplatin/5-FU", "C. 直接放弃同期治疗", "D. 只能改用 PD-1 单药"], "explanation": "当患者cisplatin ineligible/intolerant时，NCCN允许用carboplatin + RT followed by carboplatin/5-FU作为替代。并不是只能直接放弃系统治疗。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "Carboplatin + RT followed by carboplatin/5-FU", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "III. 成人非转移性NPC初治", "scope_minor": "III-C. 同期药物、给药方式与禁忌"} |
| {"id": "l1-sample-159c09d9f4c42ab9270a799d", "question": "根据 CSCO 2025，对可切除的局部复发鼻咽癌，最符合“局部根治优先”理念的治疗是：", "options": {"A": "挽救性手术，优先考虑经鼻内镜微创切除", "B": "一律先二线免疫", "C": "一律先再程放疗", "D": "只做支持治疗"}, "answer": "A", "choices": ["A. 挽救性手术，优先考虑经鼻内镜微创切除", "B. 一律先二线免疫", "C. 一律先再程放疗", "D. 只做支持治疗"], "explanation": "可切除局部复发鼻咽癌按CSCO应优先考虑挽救性手术，且经鼻内镜微创路径越来越成为主流。并不是所有局部复发都先再放疗。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "挽救性手术，优先考虑经鼻内镜微创切除", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-414f8fab9958780316d059cc", "question": "根据 CSCO 2025，对单纯颈部淋巴结复发的患者，当前首选局部治疗方式是：", "options": {"A": "单纯化疗", "B": "一律再程放疗", "C": "单纯观察", "D": "颈部淋巴结清扫术"}, "answer": "D", "choices": ["A. 单纯化疗", "B. 一律再程放疗", "C. 单纯观察", "D. 颈部淋巴结清扫术"], "explanation": "单纯颈部淋巴结复发的首选局部治疗是颈淋巴结清扫。这里要和‘局部鼻咽复发首选挽救性手术’以及‘不可切除复发考虑再放疗/系统治疗’区分。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "颈部淋巴结清扫术", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-d492a3f6b80ca20b16e4592f", "question": "局部鼻咽复发，病灶局限，可完整切除。按CSCO，更符合局部根治优先理念的治疗是？", "options": {"A": "单纯支持治疗", "B": "一律先再程放疗", "C": "挽救性手术，优先考虑微创内镜路径", "D": "一律后线免疫"}, "answer": "C", "choices": ["A. 单纯支持治疗", "B. 一律先再程放疗", "C. 挽救性手术，优先考虑微创内镜路径", "D. 一律后线免疫"], "explanation": "CSCO明确提出：对于可手术切除的复发、残留鼻咽癌，首选手术治疗；常规鼻外径路逐渐被经鼻内镜手术替代。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗"], "answer_text": "挽救性手术，优先考虑微创内镜路径", "domain": "复发/转移性成人NPC", "source_type": "CSCO-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-5e47f6b46ef83eeb65e9f87b", "question": "仅颈部淋巴结复发，无明显原发局部复发。按CSCO，当前首选局部治疗方式是？", "options": {"A": "PD-1单药", "B": "一律再程放疗", "C": "单纯化疗", "D": "颈淋巴结清扫术"}, "answer": "D", "choices": ["A. PD-1单药", "B. 一律再程放疗", "C. 单纯化疗", "D. 颈淋巴结清扫术"], "explanation": "对单纯颈部淋巴结复发，CSCO强调颈部淋巴结清扫术是当前首选局部治疗。它与局部鼻咽复发首选挽救性手术是并列但不同的场景。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗"], "answer_text": "颈淋巴结清扫术", "domain": "复发/转移性成人NPC", "source_type": "CSCO-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-87c03f69152d821abbf70cb1", "question": "根据 CSCO 2025，对不可手术复发鼻咽癌，以下最准确的是：", "options": {"A": "一律放弃局部治疗", "B": "只能免疫单药", "C": "所有患者都应再程放疗", "D": "需结合风险分层决定是否再程放疗"}, "answer": "D", "choices": ["A. 一律放弃局部治疗", "B. 只能免疫单药", "C. 所有患者都应再程放疗", "D. 需结合风险分层决定是否再程放疗"], "explanation": "CSCO把不可手术复发患者分为高危/低危，不是所有人都适合再程放疗。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗；NCCN 2025 ADV-3/ADV-A", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗", "NCCN 2025 ADV-3/ADV-A"], "answer_text": "需结合风险分层决定是否再程放疗", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-427a6750f40d24aadf7ef074", "question": "根据 NCCN 2025，复发/持续病变术后若存在最核心的高危病理特征（如ENE或阳性切缘），推荐：", "options": {"A": "只做PET/CT复查", "B": "只做口服卡培他滨", "C": "systemic therapy/RT", "D": "仅观察"}, "answer": "C", "choices": ["A. 只做PET/CT复查", "B. 只做口服卡培他滨", "C. systemic therapy/RT", "D. 仅观察"], "explanation": "NCCN ADV-3 对术后高危病理特征推荐 systemic therapy/RT。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗；NCCN 2025 ADV-3/ADV-A", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗", "NCCN 2025 ADV-3/ADV-A"], "answer_text": "systemic therapy/RT", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-39be6f7308424437af960900", "question": "根据 CSCO 2025，关于不可手术局部复发患者的分层与再程放疗，下列哪项最准确？", "options": {"A": "不可手术即只做最佳支持治疗", "B": "所有不可手术患者都应立即再程放疗", "C": "不可手术即直接改用儿童方案", "D": "需结合高危/低危分层决定是否再程放疗"}, "answer": "D", "choices": ["A. 不可手术即只做最佳支持治疗", "B. 所有不可手术患者都应立即再程放疗", "C. 不可手术即直接改用儿童方案", "D. 需结合高危/低危分层决定是否再程放疗"], "explanation": "CSCO 复发性鼻咽癌章节明确提出：不可手术复发患者需进行风险分层，再决定是否再程放疗，而不是一刀切。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗；NCCN 2025 ADV-3/ADV-A", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗", "NCCN 2025 ADV-3/ADV-A"], "answer_text": "需结合高危/低危分层决定是否再程放疗", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-2a26680c31e7dd4f9ab18214", "question": "根据 CSCO 2025，对初治转移后获得控制、但局部复发合并远处转移的患者，更强调的治疗主轴是：", "options": {"A": "局部手术为唯一核心", "B": "统一首选颈清扫", "C": "统一首选再程放疗", "D": "以全身系统性药物治疗为主"}, "answer": "D", "choices": ["A. 局部手术为唯一核心", "B. 统一首选颈清扫", "C. 统一首选再程放疗", "D. 以全身系统性药物治疗为主"], "explanation": "CSCO 在复发分层注释中指出：局部复发合并远处转移的 IV 期患者，主要以全身系统性药物治疗为主。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗；NCCN 2025 ADV-3/ADV-A", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗", "NCCN 2025 ADV-3/ADV-A"], "answer_text": "以全身系统性药物治疗为主", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-7b0e771e1839460ad60f1153", "question": "根据 NCCN 2025，对 locoregional recurrence/persistent disease 且既往已接受放疗的患者，以下哪项最符合指南？", "options": {"A": "再放疗总是优于手术", "B": "reirradiation 应用于高度选择的患者，而非所有病例", "C": "任何既往放疗患者都只能支持治疗", "D": "只要有复发就禁止再放疗"}, "answer": "B", "choices": ["A. 再放疗总是优于手术", "B. reirradiation 应用于高度选择的患者，而非所有病例", "C. 任何既往放疗患者都只能支持治疗", "D. 只要有复发就禁止再放疗"], "explanation": "NCCN ADV-3/ADV-A 明确强调：再放疗仅适用于高度选择的患者，需具备相应条件和中心经验。", "source": "CSCO 2025 §7 复发性鼻咽癌的治疗；CSCO 2025 §8 鼻咽癌的手术治疗；NCCN 2025 ADV-3/ADV-A", "evidence_anchors": ["CSCO 2025 §7 复发性鼻咽癌的治疗", "CSCO 2025 §8 鼻咽癌的手术治疗", "NCCN 2025 ADV-3/ADV-A"], "answer_text": "reirradiation 应用于高度选择的患者，而非所有病例", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-cf53d0451a09c85a2315f42c", "question": "根据 NCCN 2025 ADV-3/ADV-4，对“既往已放疗、locoregional recurrent/persistent、且 unresectable”的患者，最符合指南的是：", "options": {"A": "必须直接进入儿童方案", "B": "reirradiation ± systemic therapy 仅适用于高度筛选病例，且 clinical trial preferred", "C": "所有病例都必须立刻再放疗", "D": "只要不可切除就只能观察"}, "answer": "B", "choices": ["A. 必须直接进入儿童方案", "B. reirradiation ± systemic therapy 仅适用于高度筛选病例，且 clinical trial preferred", "C. 所有病例都必须立刻再放疗", "D. 只要不可切除就只能观察"], "explanation": "NCCN 对既往放疗后的不可切除局部区域复发强调“高度筛选”。这类患者可考虑 reirradiation ± systemic therapy，但并非人人适合；同时 clinical trial preferred，体现的正是该路径风险高、选择性强。", "source": "NCCN 2025 ADV-3/ADV-4；NCCN 2025 ADV-A（reirradiation principles）", "evidence_anchors": ["NCCN 2025 ADV-3/ADV-4", "NCCN 2025 ADV-A（reirradiation principles）"], "answer_text": "reirradiation ± systemic therapy 仅适用于高度筛选病例，且 clinical trial preferred", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-A. 局部/区域复发与持续病灶"} |
| {"id": "l1-sample-838b7c0582002927164dc375", "question": "根据 NCCN 2025，对 M1 oligometastatic disease、PS 0–1 的患者，诱导治疗后可考虑哪一项？", "options": {"A": "RT 至原发灶、区域淋巴结及寡转移灶", "B": "仅最佳支持治疗", "C": "一律继续无限期化疗", "D": "一律不做局部治疗"}, "answer": "A", "choices": ["A. RT 至原发灶、区域淋巴结及寡转移灶", "B. 仅最佳支持治疗", "C. 一律继续无限期化疗", "D. 一律不做局部治疗"], "explanation": "NCCN 在 NASO-B 中把“诱导治疗后，对 M1 oligometastatic disease（PS 0–1）考虑 maintenance capecitabine 或整合局部治疗”作为 useful in certain circumstances。题目这里考的是系统治疗与局部治疗整合，而不是把寡转移简单等同于广泛转移。", "source": "NCCN 2025 NASO-B 1/3（M1 oligometastatic disease, PS 0–1）；CSCO 2025 第6章（寡转移综合治疗思路）", "evidence_anchors": ["NCCN 2025 NASO-B 1/3（M1 oligometastatic disease, PS 0–1）", "CSCO 2025 第6章（寡转移综合治疗思路）"], "answer_text": "RT 至原发灶、区域淋巴结及寡转移灶", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-cd9237acd2b5ca048d0d2751", "question": "根据 NCCN 2025，对系统治疗后达到 CR 或 near CR 的 M1 寡转移病例，可考虑：", "options": {"A": "仅做骨扫描", "B": "立即停治观察", "C": "仅行颈清扫", "D": "definitive RT to primary and regional nodes（preferred）"}, "answer": "D", "choices": ["A. 仅做骨扫描", "B. 立即停治观察", "C. 仅行颈清扫", "D. definitive RT to primary and regional nodes（preferred）"], "explanation": "对系统治疗后达到CR或near CR的M1寡转移病例，NCCN preferred是对原发灶和区域淋巴结行definitive RT，并按需要处理寡转移灶。不是简单停治观察。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "definitive RT to primary and regional nodes（preferred）", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-878a7f699523ed0c87efac75", "question": "M1寡转移、PS 0–1患者接受诱导治疗后达到near CR。按NCCN，下一步更符合指南的是？", "options": {"A": "对原发灶和区域淋巴结行definitive RT，并按需处理寡转移灶", "B": "只继续无限期化疗，不再做局部治疗", "C": "立即停治观察", "D": "仅做颈清扫"}, "answer": "A", "choices": ["A. 对原发灶和区域淋巴结行definitive RT，并按需处理寡转移灶", "B. 只继续无限期化疗，不再做局部治疗", "C. 立即停治观察", "D. 仅做颈清扫"], "explanation": "NCCN对寡转移、治疗后达到CR/near CR的患者强调局部根治整合：preferred是对原发灶和区域淋巴结做definitive RT，并根据情况处理寡转移灶。", "source": "NCCN 2025 NASO-3；NCCN 2025 NASO-B（M1 oligometastatic disease）", "evidence_anchors": ["NCCN 2025 NASO-3", "NCCN 2025 NASO-B（M1 oligometastatic disease）"], "answer_text": "对原发灶和区域淋巴结行definitive RT，并按需处理寡转移灶", "domain": "复发/转移性成人NPC", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-a78431dd3fdad8aafbfb844c", "question": "广泛转移鼻咽癌，PS 3–4。按NCCN，更符合的处理是？", "options": {"A": "诱导后再并放", "B": "最佳支持治疗", "C": "一律加toripalimab+GP", "D": "三药强化化疗"}, "answer": "B", "choices": ["A. 诱导后再并放", "B. 最佳支持治疗", "C. 一律加toripalimab+GP", "D. 三药强化化疗"], "explanation": "NCCN对widely metastatic且poor PS（3–4）患者强调最佳支持治疗。PS是系统治疗个体化选择的前提，不能机械套用高强度方案。", "source": "NCCN 2025 ADV-3/ADV-4（widely metastatic disease, PS分层）", "evidence_anchors": ["NCCN 2025 ADV-3/ADV-4（widely metastatic disease, PS分层）"], "answer_text": "最佳支持治疗", "domain": "复发/转移性成人NPC", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-e614b7239caf36a87ebb090b", "question": "根据 NCCN 2025 NASO-B，对 M1 oligometastatic disease 且 PS 0–1 的患者，诱导化疗后可考虑的“useful in certain circumstances”策略是：", "options": {"A": "必须立即手术切除所有病灶", "B": "maintenance capecitabine without concurrent RT", "C": "固定进入免疫单药二线", "D": "只能最佳支持治疗"}, "answer": "B", "choices": ["A. 必须立即手术切除所有病灶", "B. maintenance capecitabine without concurrent RT", "C. 固定进入免疫单药二线", "D. 只能最佳支持治疗"], "explanation": "NCCN NASO-B 写明：对于 M1 oligometastatic disease（PS 0–1），诱导化疗后可考虑 maintenance capecitabine without concurrent RT。", "source": "NCCN 2025 NASO-3；NCCN 2025 NASO-B（M1 oligometastatic disease）", "evidence_anchors": ["NCCN 2025 NASO-3", "NCCN 2025 NASO-B（M1 oligometastatic disease）"], "answer_text": "maintenance capecitabine without concurrent RT", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-109df2ac03913a99c35acc68", "question": "根据 NCCN 2025 ADV-3/ADV-4，对“初诊即 M1、widely metastatic、PS 0–2”的患者，下列哪项最符合 very advanced 框架？", "options": {"A": "必须直接最佳支持治疗", "B": "可考虑 combination systemic therapy 或 single-agent systemic therapy；对有限转移者可选择性整合 surgery/RT/系统治疗；亦可最佳支持治疗", "C": "只要是 M1 就必须手术", "D": "只能做局部再放疗"}, "answer": "B", "choices": ["A. 必须直接最佳支持治疗", "B. 可考虑 combination systemic therapy 或 single-agent systemic therapy；对有限转移者可选择性整合 surgery/RT/系统治疗；亦可最佳支持治疗", "C. 只要是 M1 就必须手术", "D. 只能做局部再放疗"], "explanation": "NCCN 对初诊转移但 PS 尚可的患者给出的不是单一路径，而是“系统治疗为主，可按病灶范围整合局部治疗，也可根据整体状态选择 BSC”。题目的关键在于不要把“widely metastatic”与“完全没有任何治疗选择”画上等号。", "source": "NCCN 2025 ADV-3/ADV-4（widely metastatic disease, PS 0–2）", "evidence_anchors": ["NCCN 2025 ADV-3/ADV-4（widely metastatic disease, PS 0–2）"], "answer_text": "可考虑 combination systemic therapy 或 single-agent systemic therapy；对有限转移者可选择性整合 surgery/RT/系统治疗；亦可最佳支持治疗", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-0700af2e1adc88ad9faed685", "question": "根据 NCCN 2025 ADV-3/ADV-4，对 widely metastatic 且 poor PS（3–4）的患者，最符合指南的是：", "options": {"A": "PS 3–4 与 PS 0–1 完全采用同一策略", "B": "优先 combination systemic therapy", "C": "必须局部根治性放疗", "D": "PS 3 可考虑 single-agent systemic therapy 或 BSC ± palliative RT/surgery；PS 4 以 BSC ± palliative RT 为主"}, "answer": "D", "choices": ["A. PS 3–4 与 PS 0–1 完全采用同一策略", "B. 优先 combination systemic therapy", "C. 必须局部根治性放疗", "D. PS 3 可考虑 single-agent systemic therapy 或 BSC ± palliative RT/surgery；PS 4 以 BSC ± palliative RT 为主"], "explanation": "NCCN 在 ADV-3/ADV-4 中把 poor PS 与 good PS 明确分层。PS 3 仍可在个体化前提下考虑较弱化的系统治疗或姑息局部治疗；PS 4 则以最佳支持治疗为主，必要时加姑息放疗。", "source": "NCCN 2025 ADV-3/ADV-4（PS 3–4 分层）", "evidence_anchors": ["NCCN 2025 ADV-3/ADV-4（PS 3–4 分层）"], "answer_text": "PS 3 可考虑 single-agent systemic therapy 或 BSC ± palliative RT/surgery；PS 4 以 BSC ± palliative RT 为主", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-B. 寡转移与广泛转移管理"} |
| {"id": "l1-sample-bd06967e87dd95f8a7a8960d", "question": "根据 NCCN 2025，对 recurrent/unresectable/oligometastatic/metastatic NPC（且无局部手术或 RT 机会），preferred first-line regimen 是：", "options": {"A": "cisplatin/gemcitabine + toripalimab-tpzi", "B": "PF", "C": "paclitaxel 单药", "D": "cetuximab 单药"}, "answer": "A", "choices": ["A. cisplatin/gemcitabine + toripalimab-tpzi", "B. PF", "C. paclitaxel 单药", "D. cetuximab 单药"], "explanation": "在 NCCN 2025 的 NASO-B 中，cisplatin/gemcitabine + toripalimab-tpzi 是这一场景下的 preferred first-line regimen。PF、单药紫杉醇和单药 cetuximab 均不属于 preferred first-line。", "source": "NCCN 2025 NASO-B 1/3（Recurrent/Unresectable/Oligometastatic/Metastatic Disease, Preferred First-Line）；CSCO 2025 第6章、表12–13", "evidence_anchors": ["NCCN 2025 NASO-B 1/3（Recurrent/Unresectable/Oligometastatic/Metastatic Disease, Preferred First-Line）", "CSCO 2025 第6章、表12–13"], "answer_text": "cisplatin/gemcitabine + toripalimab-tpzi", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-6b5eef68ed781f733269c86a", "question": "根据 CSCO 2025，关于RM-NPC一线高等级推荐，以下哪项表述最准确？", "options": {"A": "一线1A类只包括GP本身，不包括任何免疫联合", "B": "只有toripalimab+GP属于1A类，其他PD-1联合均为2A类", "C": "GP+camrelizumab、GP+toripalimab、GP+tislelizumab、GP+tagitanlimab均已进入1A类，而pembrolizumab单药不属于这一层级", "D": "所有PD-1单药均属于1A类一线标准"}, "answer": "C", "choices": ["A. 一线1A类只包括GP本身，不包括任何免疫联合", "B. 只有toripalimab+GP属于1A类，其他PD-1联合均为2A类", "C. GP+camrelizumab、GP+toripalimab、GP+tislelizumab、GP+tagitanlimab均已进入1A类，而pembrolizumab单药不属于这一层级", "D. 所有PD-1单药均属于1A类一线标准"], "explanation": "CSCO 2025 在 RM-NPC 一线 1A 类中已纳入 GP+camrelizumab、GP+toripalimab、GP+tislelizumab 以及 GP+tagitanlimab；pembrolizumab 单药并不属于这一层级的一线标准方案。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "GP+camrelizumab、GP+toripalimab、GP+tislelizumab、GP+tagitanlimab均已进入1A类，而pembrolizumab单药不属于这一层级", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-4b2277551b3df02789c057e4", "question": "根据 CSCO 2025，一线 GP 方案中，吉西他滨和顺铂的常用剂量是？", "options": {"A": "Gemcitabine 1250 mg/m² d1,15 + cisplatin 100 mg/m² d1", "B": "Gemcitabine 1000 mg/m² d1,8 + cisplatin 80 mg/m² d1", "C": "Gemcitabine 800 mg/m² d1,8 + cisplatin 75 mg/m² d1", "D": "Gemcitabine 1000 mg/m² d1 + carboplatin AUC5"}, "answer": "B", "choices": ["A. Gemcitabine 1250 mg/m² d1,15 + cisplatin 100 mg/m² d1", "B. Gemcitabine 1000 mg/m² d1,8 + cisplatin 80 mg/m² d1", "C. Gemcitabine 800 mg/m² d1,8 + cisplatin 75 mg/m² d1", "D. Gemcitabine 1000 mg/m² d1 + carboplatin AUC5"], "explanation": "CSCO一线GP方案的标准记忆点是吉西他滨1000 mg/m² d1,8 + 顺铂80 mg/m² d1，q3w。其他剂量多属于干扰项或非主流写法。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "Gemcitabine 1000 mg/m² d1,8 + cisplatin 80 mg/m² d1", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-43822928709a42ac756c8b17", "question": "根据 CSCO 2025，一线 GP + toripalimab 中，toripalimab 常用剂量是？", "options": {"A": "240 mg q3w", "B": "3 mg/kg q2w", "C": "1200 mg q3w", "D": "200 mg q2w"}, "answer": "A", "choices": ["A. 240 mg q3w", "B. 3 mg/kg q2w", "C. 1200 mg q3w", "D. 200 mg q2w"], "explanation": "一线GP + toripalimab中，toripalimab常用剂量是240 mg q3w。不要和后线单药3 mg/kg q2w混淆。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "240 mg q3w", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-b1c81ea0de4fc63799e5b923", "question": "根据 CSCO 2025，一线 GP + camrelizumab 中，camrelizumab 常用剂量是？", "options": {"A": "240 mg q3w", "B": "200 mg q3w", "C": "200 mg q2w", "D": "3 mg/kg q2w"}, "answer": "B", "choices": ["A. 240 mg q3w", "B. 200 mg q3w", "C. 200 mg q2w", "D. 3 mg/kg q2w"], "explanation": "一线GP + camrelizumab时，camrelizumab常用剂量是200 mg q3w。它和后线单药200 mg q2w正好构成经典剂量陷阱。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "200 mg q3w", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-f14c468c74200e82db0bc293", "question": "根据 CSCO 2025，一线 GP + tislelizumab 方案中，tislelizumab 的常用给药为：", "options": {"A": "200 mg q3w", "B": "200 mg q2w", "C": "240 mg q3w", "D": "1200 mg q3w"}, "answer": "A", "choices": ["A. 200 mg q3w", "B. 200 mg q2w", "C. 240 mg q3w", "D. 1200 mg q3w"], "explanation": "这题考的是“具体给药表”。CSCO 表13所列 GP + 替雷利珠单抗方案中，替雷利珠单抗常用剂量为 200 mg q3w。其余选项来自其他 PD-1/PD-L1 药物的常见干扰剂量或错误周期。", "source": "CSCO 2025 表13（转移性鼻咽癌方案与剂量）；NCCN 2025 NASO-B（免疫联合总体路径）", "evidence_anchors": ["CSCO 2025 表13（转移性鼻咽癌方案与剂量）", "NCCN 2025 NASO-B（免疫联合总体路径）"], "answer_text": "200 mg q3w", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-965b5efa74546310acdff5e5", "question": "根据 CSCO 2025，下列哪项属于一线 2A类方案？", "options": {"A": "nivolumab/ipilimumab", "B": "pembrolizumab 单药", "C": "methotrexate 单药", "D": "cisplatin/carboplatin + 5-FU"}, "answer": "D", "choices": ["A. nivolumab/ipilimumab", "B. pembrolizumab 单药", "C. methotrexate 单药", "D. cisplatin/carboplatin + 5-FU"], "explanation": "CSCO一线2A类可以包括cisplatin/carboplatin + 5-FU，而不是直接上免疫单药或双免疫。题目考的是一线层级结构而非单个药名。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "cisplatin/carboplatin + 5-FU", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-fa31fb3d888b521ce0e2caa4", "question": "根据 CSCO 2025，下列哪项属于 RM-NPC 一线 2B类方案？", "options": {"A": "GP + Endostar", "B": "GP + toripalimab", "C": "GP + camrelizumab", "D": "GP"}, "answer": "A", "choices": ["A. GP + Endostar", "B. GP + toripalimab", "C. GP + camrelizumab", "D. GP"], "explanation": "CSCO 2025 表12/表13中，GP + Endostar 属于一线 2B类方案。GP 单药及若干 GP + PD-1 组合的证据等级更高，因此不能把“常见”误判成“2B”。", "source": "CSCO 2025 表12–13（RM-NPC 一线分层与方案）；NCCN 2025 NASO-B（对应总体框架）", "evidence_anchors": ["CSCO 2025 表12–13（RM-NPC 一线分层与方案）", "NCCN 2025 NASO-B（对应总体框架）"], "answer_text": "GP + Endostar", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-87976b33d1065ee12cadf77b", "question": "根据 NCCN 2025，下列哪一项属于 preferred first-line regimen？", "options": {"A": "cisplatin/gemcitabine", "B": "carboplatin/gemcitabine", "C": "cisplatin/5-FU", "D": "cisplatin/gemcitabine + toripalimab-tpzi"}, "answer": "D", "choices": ["A. cisplatin/gemcitabine", "B. carboplatin/gemcitabine", "C. cisplatin/5-FU", "D. cisplatin/gemcitabine + toripalimab-tpzi"], "explanation": "NCCN 2025 仅将 cisplatin/gemcitabine + toripalimab-tpzi 列为 preferred first-line；cisplatin/gemcitabine、cisplatin/5-FU 和 carboplatin/gemcitabine 都被放在 other recommended first-line 层级。", "source": "NCCN 2025 NASO-B 1/3（Preferred vs Other Recommended First-Line）；CSCO 2025 第6章、表12–13", "evidence_anchors": ["NCCN 2025 NASO-B 1/3（Preferred vs Other Recommended First-Line）", "CSCO 2025 第6章、表12–13"], "answer_text": "cisplatin/gemcitabine + toripalimab-tpzi", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-a77d9e807490d13e7f52303b", "question": "关于camrelizumab在RM-NPC中的用法，下列哪项配对正确？", "options": {"A": "一线GP联合：200 mg q2w；后线单药：200 mg q3w", "B": "一线GP联合：200 mg q3w；后线单药：200 mg q2w", "C": "一线和后线均为3 mg/kg q2w", "D": "一线和后线均为240 mg q3w"}, "answer": "B", "choices": ["A. 一线GP联合：200 mg q2w；后线单药：200 mg q3w", "B. 一线GP联合：200 mg q3w；后线单药：200 mg q2w", "C. 一线和后线均为3 mg/kg q2w", "D. 一线和后线均为240 mg q3w"], "explanation": "camrelizumab同样存在场景性剂量差异：一线与GP联合时通常200 mg q3w，至少二线失败后单药常用200 mg q2w。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗；表13/表16；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗；表13/表16", "NCCN 2025 NASO-B"], "answer_text": "一线GP联合：200 mg q3w；后线单药：200 mg q2w", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-b40af8e4e1d0c6fbe390b7fc", "question": "根据 CSCO 2025，与2024版相比，RM-NPC 一线 1A类方案中新增的免疫联合化疗是：", "options": {"A": "GP + 帕博利珠单抗", "B": "GP + 塔戈利单抗", "C": "GP + 派安普利单抗", "D": "GP + 纳武利尤单抗"}, "answer": "B", "choices": ["A. GP + 帕博利珠单抗", "B. GP + 塔戈利单抗", "C. GP + 派安普利单抗", "D. GP + 纳武利尤单抗"], "explanation": "2024版一线1A类为 GP+卡瑞利珠单抗/特瑞普利单抗/替雷利珠单抗及 GP；2025版新增 GP+塔戈利单抗 为 1A类。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗；CSCO 2025 表12–13/表16（RM-NPC 方案与免疫注释）", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗", "CSCO 2025 表12–13/表16（RM-NPC 方案与免疫注释）"], "answer_text": "GP + 塔戈利单抗", "domain": "复发/转移性成人NPC", "source_type": "CSCO-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-28db9919b9b0ec95f4ae613b", "question": "根据 CSCO 2025，关于 RM-NPC 一线治疗的表述，最准确的是：", "options": {"A": "一线标准仍仅限 GP，不推荐免疫联合", "B": "一线首选为 nivolumab + ipilimumab", "C": "一线标准治疗为 GP + PD-1/PD-L1 单抗", "D": "一线首选为单药特瑞普利单抗"}, "answer": "C", "choices": ["A. 一线标准仍仅限 GP，不推荐免疫联合", "B. 一线首选为 nivolumab + ipilimumab", "C. 一线标准治疗为 GP + PD-1/PD-L1 单抗", "D. 一线首选为单药特瑞普利单抗"], "explanation": "按 CSCO 2025，RM-NPC 一线标准治疗已从单纯 GP 化疗扩展为 GP 联合免疫检查点抑制剂的框架；当前 1A 类方案既包括多种 GP+PD-1 组合，也包括 GP+tagitanlimab 这一 PD-L1 方案。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "一线标准治疗为 GP + PD-1/PD-L1 单抗", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-21eaaed5fd98db69dad2a9ac", "question": "根据 CSCO 2025，关于 RM-NPC 的一线标准治疗，哪一项表述最准确？", "options": {"A": "GP 单药始终是唯一标准", "B": "PD-1 单药已成为一线标准", "C": "GP + PD-1/PD-L1 单抗是一线标准治疗", "D": "CTLA-4/PD-1 双抗是一线首选"}, "answer": "C", "choices": ["A. GP 单药始终是唯一标准", "B. PD-1 单药已成为一线标准", "C. GP + PD-1/PD-L1 单抗是一线标准治疗", "D. CTLA-4/PD-1 双抗是一线首选"], "explanation": "2025 版 CSCO 已把“GP + PD-1/PD-L1 单抗”确立为 RM-NPC 一线标准治疗框架。GP 单药虽然仍重要，但不再代表当前最完整的一线标准；PD-1 单药和双免疫方案也不属于一线标准首选。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "GP + PD-1/PD-L1 单抗是一线标准治疗", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-98e8f235a25b93eaae3b5c22", "question": "根据 CSCO 2025，RM-NPC 一线 GP + 卡瑞利珠单抗的表格给法，最符合指南的是：", "options": {"A": "卡瑞利珠单抗200 mg q2w；联合GP最多2疗程后停药", "B": "卡瑞利珠单抗240 mg q3w；联合GP最多6疗程后停药", "C": "卡瑞利珠单抗3 mg/kg q2w；不需要维持", "D": "卡瑞利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持"}, "answer": "D", "choices": ["A. 卡瑞利珠单抗200 mg q2w；联合GP最多2疗程后停药", "B. 卡瑞利珠单抗240 mg q3w；联合GP最多6疗程后停药", "C. 卡瑞利珠单抗3 mg/kg q2w；不需要维持", "D. 卡瑞利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持"], "explanation": "CSCO 2025 转移性鼻咽癌治疗表格中，卡瑞利珠单抗联合GP的一线给法为 200 mg 每3周一次；联合化疗4–6疗程，后单药维持治疗。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "卡瑞利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-9e31fb41be350acf281e84f3", "question": "根据 CSCO 2025，RM-NPC 一线 GP + 特瑞普利单抗的表格给法，最符合指南的是：", "options": {"A": "特瑞普利单抗240 mg q6w；仅作维持", "B": "特瑞普利单抗240 mg q3w；联合GP最多6疗程，后单药维持", "C": "特瑞普利单抗200 mg q3w；联合GP最多4疗程", "D": "特瑞普利单抗3 mg/kg q2w；联合GP 4–6疗程后停药"}, "answer": "B", "choices": ["A. 特瑞普利单抗240 mg q6w；仅作维持", "B. 特瑞普利单抗240 mg q3w；联合GP最多6疗程，后单药维持", "C. 特瑞普利单抗200 mg q3w；联合GP最多4疗程", "D. 特瑞普利单抗3 mg/kg q2w；联合GP 4–6疗程后停药"], "explanation": "CSCO 2025 表格中，特瑞普利单抗联合GP的一线给法为 240 mg 每3周一次；联合化疗最多6疗程，后单药维持治疗。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "特瑞普利单抗240 mg q3w；联合GP最多6疗程，后单药维持", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-ef626cb7d3c245722c00afde", "question": "根据 CSCO 2025，RM-NPC 一线 GP + 替雷利珠单抗的表格给法，最符合指南的是：", "options": {"A": "替雷利珠单抗3 mg/kg q2w；联合GP 2疗程", "B": "替雷利珠单抗240 mg q3w；联合GP最多6疗程", "C": "替雷利珠单抗200 mg q2w；仅单药连续使用", "D": "替雷利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持"}, "answer": "D", "choices": ["A. 替雷利珠单抗3 mg/kg q2w；联合GP 2疗程", "B. 替雷利珠单抗240 mg q3w；联合GP最多6疗程", "C. 替雷利珠单抗200 mg q2w；仅单药连续使用", "D. 替雷利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持"], "explanation": "CSCO 2025 表格中，替雷利珠单抗联合GP的一线给法为 200 mg 每3周一次；联合化疗4–6疗程，后单药维持治疗。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "替雷利珠单抗200 mg q3w；联合GP 4–6疗程，后单药维持", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-191f7d62af9c3af1421915a5", "question": "根据 CSCO 2025，顺铂/卡铂 + 5-FU 在 RM-NPC 一线 2A类方案中的周期，最符合表格的是：", "options": {"A": "21天为一个疗程，直至进展不可耐受", "B": "21天为一个疗程，4–6疗程", "C": "14天为一个疗程，固定2疗程", "D": "28天为一个疗程，最多8疗程"}, "answer": "B", "choices": ["A. 21天为一个疗程，直至进展不可耐受", "B. 21天为一个疗程，4–6疗程", "C. 14天为一个疗程，固定2疗程", "D. 28天为一个疗程，最多8疗程"], "explanation": "CSCO 转移性鼻咽癌表格中，顺铂/卡铂 + 5-FU 的典型写法为 21 天为一个疗程，4–6疗程。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "21天为一个疗程，4–6疗程", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-1cb2eff1a97dea2274bc5f0a", "question": "根据 CSCO 2025，卡铂 + 紫杉醇 作为 RM-NPC 一线 2A类方案时，表格中的关键周期特征是：", "options": {"A": "仅可用于二线以后", "B": "卡铂 AUC 5，第1天；紫杉醇 175 mg/m²，第1天；21天一疗程，4–6疗程", "C": "卡铂 AUC 2，每周一次；紫杉醇 80 mg/m²，每周一次；固定8疗程", "D": "卡铂 AUC 6，每4周一次；紫杉醇单药维持"}, "answer": "B", "choices": ["A. 仅可用于二线以后", "B. 卡铂 AUC 5，第1天；紫杉醇 175 mg/m²，第1天；21天一疗程，4–6疗程", "C. 卡铂 AUC 2，每周一次；紫杉醇 80 mg/m²，每周一次；固定8疗程", "D. 卡铂 AUC 6，每4周一次；紫杉醇单药维持"], "explanation": "CSCO 2025/2024 转移性鼻咽癌表格中，卡铂+紫杉醇的典型写法为卡铂AUC 5，第1天；紫杉醇175 mg/m²，第1天；21天一疗程，4–6疗程。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "卡铂 AUC 5，第1天；紫杉醇 175 mg/m²，第1天；21天一疗程，4–6疗程", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-7248ef187edbdc80363078e8", "question": "根据 CSCO 2025，顺铂 + 多西他赛 作为 RM-NPC 一线 2A类方案时，表格中最常见的周期写法是：", "options": {"A": "28天一疗程，最多8疗程", "B": "连续口服维持直到进展", "C": "14天一疗程，固定2疗程", "D": "21天一疗程，4–6疗程"}, "answer": "D", "choices": ["A. 28天一疗程，最多8疗程", "B. 连续口服维持直到进展", "C. 14天一疗程，固定2疗程", "D. 21天一疗程，4–6疗程"], "explanation": "CSCO 2025/2024 表格中，顺铂+多西他赛作为2A类方案时，均以21天为一个疗程，4–6疗程书写。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "21天一疗程，4–6疗程", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-710dbfea19605e17f3607bf3", "question": "根据 CSCO 2025 表12，下列哪项属于 RM-NPC 一线 2A类，而不是 1A/1B/2B类？", "options": {"A": "吉西他滨 + 顺铂 + 塔戈利单抗", "B": "紫杉醇或白蛋白紫杉醇 + 顺铂 + 卡培他滨", "C": "卡培他滨 + 顺铂", "D": "吉西他滨 + 顺铂 + 恩度"}, "answer": "C", "choices": ["A. 吉西他滨 + 顺铂 + 塔戈利单抗", "B. 紫杉醇或白蛋白紫杉醇 + 顺铂 + 卡培他滨", "C. 卡培他滨 + 顺铂", "D. 吉西他滨 + 顺铂 + 恩度"], "explanation": "2025 CSCO 表12 中，卡培他滨 + 顺铂被列为一线 2A类。GP + 塔戈利单抗为更高层级，紫杉醇/白蛋白紫杉醇 + 顺铂 + 卡培他滨为 1B类，GP + 恩度则为 2B类。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "卡培他滨 + 顺铂", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-a0099e295bbeef3f805b6868", "question": "根据 CSCO 2025 表13，下列哪项属于 RM-NPC 一线 2A类方案中的另一典型行？", "options": {"A": "紫杉醇或紫杉醇白蛋白 + 顺铂 + 卡培他滨", "B": "吉西他滨 + 顺铂 + 卡瑞利珠单抗", "C": "吉西他滨 + 顺铂 + 特瑞普利单抗", "D": "紫杉醇白蛋白 + 顺铂"}, "answer": "D", "choices": ["A. 紫杉醇或紫杉醇白蛋白 + 顺铂 + 卡培他滨", "B. 吉西他滨 + 顺铂 + 卡瑞利珠单抗", "C. 吉西他滨 + 顺铂 + 特瑞普利单抗", "D. 紫杉醇白蛋白 + 顺铂"], "explanation": "2025 CSCO 表13中，紫杉醇白蛋白+顺铂被列为一线 2A类；其余选项分别为1A或1B。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "紫杉醇白蛋白 + 顺铂", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-0aa5c1613ff9adfc5a9b3f62", "question": "根据 CSCO 2025 表12，下列哪项属于 RM-NPC 一线 2B类方案？", "options": {"A": "顺铂/卡铂 + 5-FU", "B": "吉西他滨 + 顺铂 + 恩度", "C": "卡培他滨 + 顺铂", "D": "紫杉醇或白蛋白紫杉醇 + 顺铂 + 卡培他滨"}, "answer": "B", "choices": ["A. 顺铂/卡铂 + 5-FU", "B. 吉西他滨 + 顺铂 + 恩度", "C. 卡培他滨 + 顺铂", "D. 紫杉醇或白蛋白紫杉醇 + 顺铂 + 卡培他滨"], "explanation": "在 CSCO 2025 表12 中，吉西他滨 + 顺铂 + 恩度被列为一线 2B类方案。顺铂/卡铂 + 5-FU 与卡培他滨 + 顺铂位于 2A类，紫杉醇/白蛋白紫杉醇 + 顺铂 + 卡培他滨则为 1B类。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "吉西他滨 + 顺铂 + 恩度", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-C. 一线系统治疗"} |
| {"id": "l1-sample-be75359771a64fa0198c3b21", "question": "根据 CSCO 2025，当鼻咽原发灶“复发/残留”与“放疗后纤维化”难以区分时，最符合指南的影像学策略是：", "options": {"A": "一次鼻咽镜活检阴性即可基本排除复发", "B": "仅重复增强 MRI，PET/CT 无额外价值", "C": "仅重复 PET/CT，MRI 不再需要", "D": "结合 PET/CT 与 MRI 进行综合判断"}, "answer": "D", "choices": ["A. 一次鼻咽镜活检阴性即可基本排除复发", "B. 仅重复增强 MRI，PET/CT 无额外价值", "C. 仅重复 PET/CT，MRI 不再需要", "D. 结合 PET/CT 与 MRI 进行综合判断"], "explanation": "这一题考的是“互补”而不是“二选一”。MRI 更适合局部解剖与再分期判断，PET/CT 提供代谢信息；对复发/残留与放疗后纤维化鉴别困难的情形，CSCO 更支持二者联合判读，而非单独依赖任一检查或一次阴性活检。", "source": "CSCO 2025 第2.1节影像诊断（复发/残留与纤维化鉴别）；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 第2.1节影像诊断（复发/残留与纤维化鉴别）", "NCCN 2025 NASO-1 Workup"], "answer_text": "结合 PET/CT 与 MRI 进行综合判断", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-7257f11b7128071f47093bdd", "question": "根据 NCCN 2025，对含铂治疗后进展的 NPC，preferred subsequent-line regimen 是：", "options": {"A": "toripalimab-tpzi", "B": "capecitabine", "C": "methotrexate", "D": "cetuximab"}, "answer": "A", "choices": ["A. toripalimab-tpzi", "B. capecitabine", "C. methotrexate", "D. cetuximab"], "explanation": "NCCN 2025 在 NASO-B 中把 toripalimab-tpzi 明确列为“disease progression on or after platinum-containing therapy”后的 preferred subsequent-line。capecitabine、methotrexate 等属于 other recommended subsequent-line options。", "source": "NCCN 2025 NASO-B 1/3–2/3（Preferred Subsequent-Line）；CSCO 2025 第6章、表12–13", "evidence_anchors": ["NCCN 2025 NASO-B 1/3–2/3（Preferred Subsequent-Line）", "CSCO 2025 第6章、表12–13"], "answer_text": "toripalimab-tpzi", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-0c7243c34facb8286633b348", "question": "根据 NCCN 2025，pembrolizumab 作为 useful in certain circumstances 的一个条件是？", "options": {"A": "所有 EBV 阳性", "B": "所有 RM-NPC", "C": "TMB-H（≥10 mut/Mb）", "D": "仅局部复发"}, "answer": "C", "choices": ["A. 所有 EBV 阳性", "B. 所有 RM-NPC", "C. TMB-H（≥10 mut/Mb）", "D. 仅局部复发"], "explanation": "在NCCN里，pembrolizumab作为useful in certain circumstances的一个明确条件是TMB-H（≥10 mut/Mb）。这与‘PD-L1阳性后的category 2B后线免疫’是不同条目。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "TMB-H（≥10 mut/Mb）", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-6e3cc22f883713614ec2f2af", "question": "根据 CSCO 2025，至少二线系统治疗失败后的单药 camrelizumab，常用剂量是？", "options": {"A": "3 mg/kg q2w", "B": "200 mg q2w", "C": "240 mg q3w", "D": "200 mg q3w"}, "answer": "B", "choices": ["A. 3 mg/kg q2w", "B. 200 mg q2w", "C. 240 mg q3w", "D. 200 mg q3w"], "explanation": "至少二线系统治疗失败后的单药camrelizumab常用剂量是200 mg q2w。不要和一线联合时的200 mg q3w混淆。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "200 mg q2w", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-168942faddba3241d9dcd117", "question": "根据 CSCO 2025，后线单药 toripalimab 常用剂量是？", "options": {"A": "3 mg/kg q2w", "B": "240 mg q3w", "C": "200 mg q3w", "D": "200 mg q2w"}, "answer": "A", "choices": ["A. 3 mg/kg q2w", "B. 240 mg q3w", "C. 200 mg q3w", "D. 200 mg q2w"], "explanation": "后线单药toripalimab常用剂量是3 mg/kg q2w。这正是同药不同场景不同剂量的高频陷阱。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "3 mg/kg q2w", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-6edc01bca33053b2f6c0bef4", "question": "根据 CSCO 2025，后线单药 penpulimab 常用剂量是？", "options": {"A": "240 mg q3w", "B": "3 mg/kg q2w", "C": "1200 mg q3w", "D": "200 mg q2w"}, "answer": "D", "choices": ["A. 240 mg q3w", "B. 3 mg/kg q2w", "C. 1200 mg q3w", "D. 200 mg q2w"], "explanation": "后线单药penpulimab常用剂量是200 mg q2w。与tislelizumab或toripalimab的给法不同。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "200 mg q2w", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-178a60213a80b58330d43c26", "question": "根据 CSCO 2025，camrelizumab + apatinib 的常见后线剂量组合是：", "options": {"A": "camrelizumab 240 mg q3w + apatinib 250 mg qd", "B": "camrelizumab 200 mg q3w + apatinib 250 mg qd", "C": "camrelizumab 200 mg q2w + apatinib 500 mg qd", "D": "camrelizumab 200 mg q3w + apatinib 125 mg qd"}, "answer": "B", "choices": ["A. camrelizumab 240 mg q3w + apatinib 250 mg qd", "B. camrelizumab 200 mg q3w + apatinib 250 mg qd", "C. camrelizumab 200 mg q2w + apatinib 500 mg qd", "D. camrelizumab 200 mg q3w + apatinib 125 mg qd"], "explanation": "CSCO 所列常见后线联合方案中，卡瑞利珠单抗 + 阿帕替尼对应的是 camrelizumab 200 mg q3w + apatinib 250 mg qd。这里最容易混淆的是把单药 camrelizumab 的 q2w 周期套到联合方案中。", "source": "CSCO 2025 表13及后线治疗注释；第6章转移性鼻咽癌治疗", "evidence_anchors": ["CSCO 2025 表13及后线治疗注释", "第6章转移性鼻咽癌治疗"], "answer_text": "camrelizumab 200 mg q3w + apatinib 250 mg qd", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-d156b84a20d619341f1868ea", "question": "关于toripalimab在鼻咽癌中的给药，下列哪项配对正确？", "options": {"A": "一线和后线均为200 mg q3w", "B": "一线和后线均为200 mg q2w", "C": "一线GP联合：3 mg/kg q2w；后线单药：240 mg q3w", "D": "一线GP联合：240 mg q3w；后线单药：3 mg/kg q2w"}, "answer": "D", "choices": ["A. 一线和后线均为200 mg q3w", "B. 一线和后线均为200 mg q2w", "C. 一线GP联合：3 mg/kg q2w；后线单药：240 mg q3w", "D. 一线GP联合：240 mg q3w；后线单药：3 mg/kg q2w"], "explanation": "toripalimab是最经典的‘同药不同场景不同剂量’陷阱：一线联合GP常用240 mg q3w；含铂后单药常用3 mg/kg q2w。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗；表13/表16；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗；表13/表16", "NCCN 2025 NASO-B"], "answer_text": "一线GP联合：240 mg q3w；后线单药：3 mg/kg q2w", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-200463b4033182c23d1917a5", "question": "64岁RM-NPC患者，一线未接受toripalimab，现含铂后进展，PD-L1阳性。按NCCN，下列哪项最符合‘preferred subsequent-line’层级？", "options": {"A": "Capecitabine", "B": "Pembrolizumab", "C": "Nivolumab", "D": "Toripalimab-tpzi"}, "answer": "D", "choices": ["A. Capecitabine", "B. Pembrolizumab", "C. Nivolumab", "D. Toripalimab-tpzi"], "explanation": "虽然PD-L1阳性使pembrolizumab成为可选后线免疫，但NCCN把toripalimab-tpzi写为含铂后进展的preferred subsequent-line；pembrolizumab和nivolumab属于其他后线免疫条目。", "source": "NCCN 2025 NASO-B（preferred subsequent-line toripalimab-tpzi）；CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗", "evidence_anchors": ["NCCN 2025 NASO-B（preferred subsequent-line toripalimab-tpzi）", "CSCO 2025 §6 转移性鼻咽癌的治疗、§9 鼻咽癌的免疫治疗"], "answer_text": "Toripalimab-tpzi", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-2ecc30629f001ebeab616aca", "question": "既往治疗过的复发/转移性非角化型NPC，当前病情进展。按NCCN，下列哪项对nivolumab的表述最准确？", "options": {"A": "属于可考虑的后线免疫，限定为既往治疗过的复发/转移性非角化型疾病", "B": "只能与gemcitabine合用", "C": "是preferred subsequent-line，优先于toripalimab", "D": "仅限PD-L1阳性患者"}, "answer": "A", "choices": ["A. 属于可考虑的后线免疫，限定为既往治疗过的复发/转移性非角化型疾病", "B. 只能与gemcitabine合用", "C. 是preferred subsequent-line，优先于toripalimab", "D. 仅限PD-L1阳性患者"], "explanation": "NCCN对nivolumab的限定很具体：既往治疗过、复发/转移、非角化型疾病，category 2B。它不是preferred subsequent-line，也不要求PD-L1阳性。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "属于可考虑的后线免疫，限定为既往治疗过的复发/转移性非角化型疾病", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-04f1518b6304792cc3aceb25", "question": "根据 CSCO 2025，关于 RM-NPC 二线/多线治疗，以下哪项更符合 2025 版趋势？", "options": {"A": "二线及以上仍鼓励临床试验，单药化疗仍是重要基石之一", "B": "所有既往 PD-1 失败患者都直接进入 CTLA-4 双抗标准方案", "C": "二线后不再建议任何系统治疗", "D": "PD-1 单药已完全取代单药化疗成为二线Ⅰ级推荐"}, "answer": "A", "choices": ["A. 二线及以上仍鼓励临床试验，单药化疗仍是重要基石之一", "B. 所有既往 PD-1 失败患者都直接进入 CTLA-4 双抗标准方案", "C. 二线后不再建议任何系统治疗", "D. PD-1 单药已完全取代单药化疗成为二线Ⅰ级推荐"], "explanation": "CSCO 2025 仍保留单药化疗为二线及以上的重要组成，并鼓励临床试验；并未把所有二线地位完全交给单药 PD-1。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "二线及以上仍鼓励临床试验，单药化疗仍是重要基石之一", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-b9693e8aa16ae40af764f984", "question": "根据 CSCO 2025，下列哪项最符合 2025 版对后线派安普利单抗的定位？", "options": {"A": "仅用于儿童局部复发", "B": "仅用于局部晚期同步放疗", "C": "一线联合 GP 的 1A类方案", "D": "至少二线系统治疗失败后的单药选择之一"}, "answer": "D", "choices": ["A. 仅用于儿童局部复发", "B. 仅用于局部晚期同步放疗", "C. 一线联合 GP 的 1A类方案", "D. 至少二线系统治疗失败后的单药选择之一"], "explanation": "2025版仍把派安普利单抗放在至少二线系统治疗失败后的复发/转移单药场景。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "至少二线系统治疗失败后的单药选择之一", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-8de2569f3d785fdbae5b6bb8", "question": "根据 CSCO 2025，关于阿帕替尼相关方案，最需要警惕的临床问题是：", "options": {"A": "一定导致听力永久恢复", "B": "可替代所有化疗方案成为一线标准", "C": "对既往再放疗/鼻咽局部复发患者，鼻咽坏死风险值得特别警惕", "D": "显著增加甲状腺功能减退"}, "answer": "C", "choices": ["A. 一定导致听力永久恢复", "B. 可替代所有化疗方案成为一线标准", "C. 对既往再放疗/鼻咽局部复发患者，鼻咽坏死风险值得特别警惕", "D. 显著增加甲状腺功能减退"], "explanation": "CSCO 2024/2025 注释中强调阿帕替尼相关方案在特定复发鼻咽患者中鼻咽坏死风险值得警惕，尤其既往再放疗/局部病灶者。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "对既往再放疗/鼻咽局部复发患者，鼻咽坏死风险值得特别警惕", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-8822c0a252347e066d481ab6", "question": "根据 CSCO 2025，对接受 GP+PD-1/PD-L1 一线治疗后未进展的 RM-NPC 患者，后续最符合指南的是：", "options": {"A": "统一换成卡培他滨维持", "B": "继续无限期联合化疗", "C": "改为 PD-1/PD-L1 单药维持，直至不可耐受、疾病进展或满2年", "D": "立即停药观察"}, "answer": "C", "choices": ["A. 统一换成卡培他滨维持", "B. 继续无限期联合化疗", "C. 改为 PD-1/PD-L1 单药维持，直至不可耐受、疾病进展或满2年", "D. 立即停药观察"], "explanation": "CSCO 2025 的序贯总结明确指出：接受一线 GP+PD-1/PD-L1 治疗且化疗后未进展者，可转入 PD-1/PD-L1 单药维持，直至不可耐受、疾病进展或满2年；不建议继续联合或单用化疗药物维持。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "改为 PD-1/PD-L1 单药维持，直至不可耐受、疾病进展或满2年", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-b497247a89a0160c71d0120e", "question": "根据 CSCO 2025，对一线“仅接受化疗”且未进展的 RM-NPC 患者，指南允许考虑的维持策略之一是：", "options": {"A": "固定改用伊匹木单抗", "B": "口服氟尿嘧啶类维持（如卡培他滨或 S-1）", "C": "所有患者都必须局部放疗维持", "D": "固定改用纳武利尤单抗"}, "answer": "B", "choices": ["A. 固定改用伊匹木单抗", "B. 口服氟尿嘧啶类维持（如卡培他滨或 S-1）", "C. 所有患者都必须局部放疗维持", "D. 固定改用纳武利尤单抗"], "explanation": "对一线仅接受化疗且疾病未进展的 RM-NPC 患者，CSCO 允许考虑口服氟尿嘧啶类维持，如卡培他滨或 S-1。这里强调的是“可考虑的维持策略”，并非对所有患者一刀切地转换为免疫药或局部放疗。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "口服氟尿嘧啶类维持（如卡培他滨或 S-1）", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-e55ac59f9fb92bd810b745c6", "question": "根据 CSCO 2025，为什么 RM-NPC 在一线含铂治疗失败后，二线仍保留单药化疗的重要地位？", "options": {"A": "因为二线时只能重复一线 GP", "B": "因为二线后所有患者都不再适合系统治疗", "C": "因为目前暂无高级别循证优选二线方案，单药化疗仍是重要基石之一", "D": "因为二线免疫已被证实明显优于化疗，所以化疗只是历史遗留"}, "answer": "C", "choices": ["A. 因为二线时只能重复一线 GP", "B. 因为二线后所有患者都不再适合系统治疗", "C. 因为目前暂无高级别循证优选二线方案，单药化疗仍是重要基石之一", "D. 因为二线免疫已被证实明显优于化疗，所以化疗只是历史遗留"], "explanation": "CSCO 2025 的关键表述是：一线含铂方案失败后，二线及以上尚无高级别循证优选方案，因此单药化疗仍保留重要地位。也正因如此，题目考的不是“化疗过时了没有”，而是“在证据真空区仍需保留什么”。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "因为目前暂无高级别循证优选二线方案，单药化疗仍是重要基石之一", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-a139fd4468b6e49b23252afe", "question": "根据 CSCO 2025，下列哪组更符合 RM-NPC 二线及以上单药化疗的 2A类推荐？", "options": {"A": "特瑞普利单抗 / 卡瑞利珠单抗 / 派安普利单抗 均为二线1A", "B": "卡培他滨 / 多西他赛 / 吉西他滨（如一线未接受同一药物之一）", "C": "仅限甲氨蝶呤单药", "D": "顺铂 / 吉西他滨 / 5-FU 必须原方案重打"}, "answer": "B", "choices": ["A. 特瑞普利单抗 / 卡瑞利珠单抗 / 派安普利单抗 均为二线1A", "B. 卡培他滨 / 多西他赛 / 吉西他滨（如一线未接受同一药物之一）", "C. 仅限甲氨蝶呤单药", "D. 顺铂 / 吉西他滨 / 5-FU 必须原方案重打"], "explanation": "2025版二线及以上单药化疗的2A类保留卡培他滨、多西他赛、吉西他滨，前提是前线未接受同一药物之一。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "卡培他滨 / 多西他赛 / 吉西他滨（如一线未接受同一药物之一）", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-bc2e578b4ba810d1e3a10783", "question": "根据 CSCO 2025，下列哪项更符合 RM-NPC 二线及以上联合化疗的 2A类推荐？", "options": {"A": "CTLA-4+PD-1 双抗为统一二线标准", "B": "所有二线患者必须改用放疗", "C": "阿帕替尼+卡培他滨已升为二线1A", "D": "吉西他滨+长春瑞滨 或 伊立替康（如一线未接受同一药物）"}, "answer": "D", "choices": ["A. CTLA-4+PD-1 双抗为统一二线标准", "B. 所有二线患者必须改用放疗", "C. 阿帕替尼+卡培他滨已升为二线1A", "D. 吉西他滨+长春瑞滨 或 伊立替康（如一线未接受同一药物）"], "explanation": "2025版二线及以上联合化疗 2A类保留吉西他滨+长春瑞滨和伊立替康，并强调前线未接受同一药物。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "吉西他滨+长春瑞滨 或 伊立替康（如一线未接受同一药物）", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-37754a54f2c4dcb60c2ad681", "question": "根据 CSCO 2025，关于后线免疫药物进入条件，下列哪项最准确？", "options": {"A": "特瑞普利单抗可用于至少一线失败或放化疗结束后6个月内进展，而卡瑞利珠单抗/派安普利单抗通常要求至少二线失败", "B": "所有后线免疫都只限 PD-L1 TPS≥1%", "C": "所有后线免疫都要求至少三线失败", "D": "卡瑞利珠单抗、派安普利单抗、特瑞普利单抗的进入条件完全相同"}, "answer": "A", "choices": ["A. 特瑞普利单抗可用于至少一线失败或放化疗结束后6个月内进展，而卡瑞利珠单抗/派安普利单抗通常要求至少二线失败", "B. 所有后线免疫都只限 PD-L1 TPS≥1%", "C. 所有后线免疫都要求至少三线失败", "D. 卡瑞利珠单抗、派安普利单抗、特瑞普利单抗的进入条件完全相同"], "explanation": "特瑞普利单抗的进入条件较早，可用于至少一线失败或辅助/放化疗结束后6个月内进展；卡瑞利珠单抗和派安普利单抗通常要求至少二线系统治疗失败。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "特瑞普利单抗可用于至少一线失败或放化疗结束后6个月内进展，而卡瑞利珠单抗/派安普利单抗通常要求至少二线失败", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-b2f9486d057c1e771ac7bd47", "question": "根据 CSCO 2025，卡瑞利珠单抗 + 阿帕替尼更适合哪类患者？", "options": {"A": "至少一线系统治疗失败，或诱导/同期/辅助放化疗结束后6个月内进展，且不适合放疗及手术的复发/转移患者", "B": "所有初治转移患者的一线标准", "C": "仅儿童复发患者", "D": "仅T1N0局部病灶"}, "answer": "A", "choices": ["A. 至少一线系统治疗失败，或诱导/同期/辅助放化疗结束后6个月内进展，且不适合放疗及手术的复发/转移患者", "B. 所有初治转移患者的一线标准", "C. 仅儿童复发患者", "D. 仅T1N0局部病灶"], "explanation": "CSCO 对该方案给出的适用人群写得很具体：至少一线失败，或放化疗结束后6个月内进展，且不适合放疗及手术。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "至少一线系统治疗失败，或诱导/同期/辅助放化疗结束后6个月内进展，且不适合放疗及手术的复发/转移患者", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-b2d2349edab21a111176c937", "question": "根据 CSCO 2025，关于三线及以上治疗，最符合序贯逻辑的是：", "options": {"A": "三线后统一停治", "B": "若既往未接受 PD-1/PD-L1，可优先考虑 PD-1/PD-L1；若既往已接受，则优先考虑前线尚未使用的单药化疗并鼓励临床试验", "C": "三线后不再区分既往是否暴露 PD-1/PD-L1", "D": "三线必须重复一线含铂方案"}, "answer": "B", "choices": ["A. 三线后统一停治", "B. 若既往未接受 PD-1/PD-L1，可优先考虑 PD-1/PD-L1；若既往已接受，则优先考虑前线尚未使用的单药化疗并鼓励临床试验", "C. 三线后不再区分既往是否暴露 PD-1/PD-L1", "D. 三线必须重复一线含铂方案"], "explanation": "2025版明确写出三线及以上需看既往是否接受过 PD-1/PD-L1：未用过可优先考虑，已用过则优先前线未用过的单药化疗，并鼓励临床试验。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "若既往未接受 PD-1/PD-L1，可优先考虑 PD-1/PD-L1；若既往已接受，则优先考虑前线尚未使用的单药化疗并鼓励临床试验", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-ccc21b2b2782427bc04c4e90", "question": "根据 CSCO 2025，下列哪项最符合 2025 版对帕博利珠单抗后线定位的表述？", "options": {"A": "帕博利珠单抗只能用于儿童", "B": "所有后线患者均 2B类", "C": "帕博利珠单抗已成为 RM-NPC 一线 1A 标准", "D": "帕博利珠单抗在二线及以上中属于 2A类，但前提是既往一线未接受 PD-1/PD-L1 抑制剂"}, "answer": "D", "choices": ["A. 帕博利珠单抗只能用于儿童", "B. 所有后线患者均 2B类", "C. 帕博利珠单抗已成为 RM-NPC 一线 1A 标准", "D. 帕博利珠单抗在二线及以上中属于 2A类，但前提是既往一线未接受 PD-1/PD-L1 抑制剂"], "explanation": "2025版表格中帕博利珠单抗在二线及以上为2A类，但附带条件是如一线未接受 PD-1/PD-L1 抑制剂。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "帕博利珠单抗在二线及以上中属于 2A类，但前提是既往一线未接受 PD-1/PD-L1 抑制剂", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-ccf1763324d32e4dc6ab0c41", "question": "根据 CSCO 2025，关于从一线转向二线的“触发条件”，哪项最符合指南语境？", "options": {"A": "只要影像学部分缓解就必须转二线", "B": "一线完成4个周期后无论疗效如何都自动进入二线", "C": "一线治疗出现疾病进展或无法耐受毒性时进入后续线治疗；若一线免疫联合且未进展，则优先进入维持而非直接二线", "D": "只要 EBV DNA 不下降就立刻算二线失败"}, "answer": "C", "choices": ["A. 只要影像学部分缓解就必须转二线", "B. 一线完成4个周期后无论疗效如何都自动进入二线", "C. 一线治疗出现疾病进展或无法耐受毒性时进入后续线治疗；若一线免疫联合且未进展，则优先进入维持而非直接二线", "D. 只要 EBV DNA 不下降就立刻算二线失败"], "explanation": "最新版的核心不是按固定周期机械转线，而是按疾病进展或不可耐受毒性转线；若一线 GP+PD-1 后未进展，则先进入单药维持。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "一线治疗出现疾病进展或无法耐受毒性时进入后续线治疗；若一线免疫联合且未进展，则优先进入维持而非直接二线", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-e4f0a3123f05766b276ed8a5", "question": "根据 CSCO 2025，关于帕博利珠单抗在二线及以上治疗中的表格定位，最准确的是：", "options": {"A": "2B类，且只能用于至少二线失败后的儿童患者", "B": "1A类，且无任何前提条件", "C": "只作为一线维持，不进入二线表格", "D": "2A类，但前提是如一线未接受 PD-1/PD-L1 抑制剂"}, "answer": "D", "choices": ["A. 2B类，且只能用于至少二线失败后的儿童患者", "B. 1A类，且无任何前提条件", "C. 只作为一线维持，不进入二线表格", "D. 2A类，但前提是如一线未接受 PD-1/PD-L1 抑制剂"], "explanation": "2025版表格中，帕博利珠单抗在二线及以上治疗被列为2A类，但明确附带条件：如一线未接受 PD-1/PD-L1 抑制剂。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "2A类，但前提是如一线未接受 PD-1/PD-L1 抑制剂", "domain": "初治非转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-02a6f3e5d48a95a9fc12ef7e", "question": "根据 CSCO 2025 表13，关于 RM-NPC 二线及以上免疫治疗的推荐层级，下列哪项最符合表格？", "options": {"A": "四者均列为 1A类", "B": "只有帕博利珠单抗被列入表格", "C": "四者均列为 2A类且无前提条件", "D": "卡瑞利珠单抗、特瑞普利单抗、纳武利尤单抗均列为 2B类；帕博利珠单抗列为 2A类但要求一线未接受 PD-1/PD-L1"}, "answer": "D", "choices": ["A. 四者均列为 1A类", "B. 只有帕博利珠单抗被列入表格", "C. 四者均列为 2A类且无前提条件", "D. 卡瑞利珠单抗、特瑞普利单抗、纳武利尤单抗均列为 2B类；帕博利珠单抗列为 2A类但要求一线未接受 PD-1/PD-L1"], "explanation": "2025 CSCO 表13二线及以上治疗中，卡瑞利珠单抗、特瑞普利单抗、纳武利尤单抗均为2B类；帕博利珠单抗为2A类，但前提是一线未接受PD-1/PD-L1抑制剂。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "卡瑞利珠单抗、特瑞普利单抗、纳武利尤单抗均列为 2B类；帕博利珠单抗列为 2A类但要求一线未接受 PD-1/PD-L1", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-a931dd740dd0447270148c52", "question": "根据 NCCN 2025 NASO-B，关于 nivolumab and hyaluronidase-nvhy（皮下制剂）在鼻咽癌后线中的脚注说明，下列哪项最准确？", "options": {"A": "只能用于一线联合化疗，不能用于后线", "B": "可替代 IV nivolumab，且剂量和给药方式与 IV 完全相同", "C": "可替代 IV nivolumab，但其剂量和给药方式与 IV nivolumab 不同", "D": "NCCN 未提及该皮下制剂"}, "answer": "C", "choices": ["A. 只能用于一线联合化疗，不能用于后线", "B. 可替代 IV nivolumab，且剂量和给药方式与 IV 完全相同", "C. 可替代 IV nivolumab，但其剂量和给药方式与 IV nivolumab 不同", "D. NCCN 未提及该皮下制剂"], "explanation": "NCCN NASO-B 脚注 f 明确写到：nivolumab and hyaluronidase-nvhy 可替代 IV nivolumab，但 dosing and administration instructions different。", "source": "NCCN 2025 NASO-B（nivolumab and hyaluronidase-nvhy 脚注）", "evidence_anchors": ["NCCN 2025 NASO-B（nivolumab and hyaluronidase-nvhy 脚注）"], "answer_text": "可替代 IV nivolumab，但其剂量和给药方式与 IV nivolumab 不同", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "IV. 复发、持续病灶与转移性成人NPC", "scope_minor": "IV-D. 后线治疗、免疫与维持"} |
| {"id": "l1-sample-d865f1ce45b27f1114bd8a09", "question": "根据 CSCO 2025，鼻咽癌放疗体位固定中，指南优先推荐的组合是？", "options": {"A": "仅真空垫", "B": "仅标准树脂头枕", "C": "仅牙托，不需要热塑膜", "D": "头颈肩热塑膜 + 个体化发泡胶头颈垫"}, "answer": "D", "choices": ["A. 仅真空垫", "B. 仅标准树脂头枕", "C. 仅牙托，不需要热塑膜", "D. 头颈肩热塑膜 + 个体化发泡胶头颈垫"], "explanation": "CSCO放疗体位固定优先推荐头颈肩热塑膜联合个体化发泡胶头颈垫。单用头枕、真空垫或牙托都不足以满足鼻咽癌精确放疗需求。", "source": "CSCO 2025 §3.2 放疗流程（体位固定、CT-sim/MR-sim）；CSCO 2025 表7（定位与模拟）", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程（体位固定、CT-sim/MR-sim）", "CSCO 2025 表7（定位与模拟）"], "answer_text": "头颈肩热塑膜 + 个体化发泡胶头颈垫", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-1ade86ba3721601302a5f446", "question": "根据 CSCO 2025，鼻咽癌 CT-sim/MR-sim 的关键层厚要求更接近？", "options": {"A": "CT 和 MRI 都建议约 3 mm 层厚", "B": "仅 CT 需要薄层，MRI 无所谓", "C": "仅 MRI 需要薄层，CT 无所谓", "D": "5 mm 即可"}, "answer": "A", "choices": ["A. CT 和 MRI 都建议约 3 mm 层厚", "B. 仅 CT 需要薄层，MRI 无所谓", "C. 仅 MRI 需要薄层，CT 无所谓", "D. 5 mm 即可"], "explanation": "CSCO放疗流程中，CT-sim和MR-sim都要求约3 mm层厚，以保证靶区勾画和图像配准精度。5 mm层厚对NPC IMRT并不理想。", "source": "CSCO 2025 §3.2 放疗流程（体位固定、CT-sim/MR-sim）；CSCO 2025 表7（定位与模拟）", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程（体位固定、CT-sim/MR-sim）", "CSCO 2025 表7（定位与模拟）"], "answer_text": "CT 和 MRI 都建议约 3 mm 层厚", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-6a29f9632cca7b3179e10b2b", "question": "根据 CSCO 2025，鼻咽癌 IMRT 计划设计的更标准表述是？", "options": {"A": "所有计划都不需要剂量验证", "B": "固定野 IMRT 不推荐，必须 VMAT", "C": "推荐逆向计划；fixed-beam IMRT 常用 7–9 个共面照射野，也可用单/双弧 VMAT", "D": "只能 3D-CRT"}, "answer": "C", "choices": ["A. 所有计划都不需要剂量验证", "B. 固定野 IMRT 不推荐，必须 VMAT", "C. 推荐逆向计划；fixed-beam IMRT 常用 7–9 个共面照射野，也可用单/双弧 VMAT", "D. 只能 3D-CRT"], "explanation": "NPC IMRT计划设计通常采用逆向计划；fixed-beam IMRT常用7–9个共面照射野，也可用单/双弧VMAT。指南并没有把VMAT绝对化成唯一方案。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "推荐逆向计划；fixed-beam IMRT 常用 7–9 个共面照射野，也可用单/双弧 VMAT", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-d2c91d2fe740b26b445ede0c", "question": "根据 CSCO 2025，鼻咽癌fixed-beam IMRT常用的照射野数是：", "options": {"A": "12–14野", "B": "7–9野", "C": "3–4野", "D": "5–6野"}, "answer": "B", "choices": ["A. 12–14野", "B. 7–9野", "C. 3–4野", "D. 5–6野"], "explanation": "CSCO放疗流程指出fixed-beam IMRT通常采用7–9个照射野。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "7–9野", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-cdd4d75d7657907bb1839d87", "question": "根据 CSCO 2025，鼻咽癌放疗期间摆位验证的最低要求是：", "options": {"A": "每周1次二维验证", "B": "完全离线校正即可", "C": "每次治疗前至少2D IGRT", "D": "仅首次治疗时CBCT"}, "answer": "C", "choices": ["A. 每周1次二维验证", "B. 完全离线校正即可", "C. 每次治疗前至少2D IGRT", "D. 仅首次治疗时CBCT"], "explanation": "CSCO写明每次治疗前至少采用2D IGRT进行摆位验证。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "每次治疗前至少2D IGRT", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-bace0c654f5e8209e0c017aa", "question": "根据 CSCO 2025，关于 MRI 定位（MR-sim）参数，下列哪项最符合指南？", "options": {"A": "层厚 3 mm，层间距 0 mm", "B": "层厚 5 mm，层间距 2 mm", "C": "MRI 定位并非常规推荐", "D": "层厚 1 mm，层间距 1 mm"}, "answer": "A", "choices": ["A. 层厚 3 mm，层间距 0 mm", "B. 层厚 5 mm，层间距 2 mm", "C. MRI 定位并非常规推荐", "D. 层厚 1 mm，层间距 1 mm"], "explanation": "CSCO 在放疗流程表中写得非常具体：MRI 定位常用 T1、T2、T1 增强及 T1 压脂增强序列，层厚 3 mm，层间距 0 mm。题目考的是“表格级硬参数”，不是泛泛的流程概念。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "层厚 3 mm，层间距 0 mm", "domain": "诊断、病理与初始评估", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-e815a55d07dc7b9e92f9222e", "question": "根据 NCCN 2025 ADV-A/NASO-B，关于 concurrent systemic therapy/RT 的实施要求，哪项最符合指南？", "options": {"A": "可由任意团队实施，不强调经验和 supportive care", "B": "只要有放疗机即可，不需要系统治疗团队", "C": "只需关注化疗剂量，不必关注 supportive care", "D": "应由有经验团队实施，并包含充分 supportive care"}, "answer": "D", "choices": ["A. 可由任意团队实施，不强调经验和 supportive care", "B. 只要有放疗机即可，不需要系统治疗团队", "C. 只需关注化疗剂量，不必关注 supportive care", "D. 应由有经验团队实施，并包含充分 supportive care"], "explanation": "NCCN 明确强调：systemic therapy/RT 应由 experienced team 执行，并包含 substantial supportive care。", "source": "NCCN 2025 ADV-A；NCCN 2025 NASO-B", "evidence_anchors": ["NCCN 2025 ADV-A", "NCCN 2025 NASO-B"], "answer_text": "应由有经验团队实施，并包含充分 supportive care", "domain": "放疗技术、流程与OAR", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-A. 放疗流程、定位与实施"} |
| {"id": "l1-sample-be34e371007a87bac6d53c69", "question": "根据 NCCN 2025，对T1N0M0鼻咽癌行颈部预防照射时，推荐纳入的层面是：", "options": {"A": "II、IV、VB、VI", "B": "7A/B、II、III、VA", "C": "仅咽后区", "D": "I、IV、VI"}, "answer": "B", "choices": ["A. II、IV、VB、VI", "B. 7A/B、II、III、VA", "C. 仅咽后区", "D. I、IV、VI"], "explanation": "NCCN NASO-A 明确写明 T1N0M0 的电颈照射层面包括 7A/B、II、III、VA。", "source": "NCCN 2025 NASO-A（T1N0M0 elective neck irradiation）", "evidence_anchors": ["NCCN 2025 NASO-A（T1N0M0 elective neck irradiation）"], "answer_text": "7A/B、II、III、VA", "domain": "放疗技术、流程与OAR", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-5226557a2a81867138797158", "question": "根据 NCCN 2025，对需要 concurrent systemic therapy/RT 的鼻咽癌患者，下列哪项最符合放疗剂量分层原则？", "options": {"A": "高危区通常约 70 Gy，低至中危亚临床扩散区通常 44–50 Gy 或 54–63 Gy", "B": "所有靶区统一 70 Gy", "C": "低危区通常也要 70 Gy", "D": "NCCN 不区分风险区剂量"}, "answer": "A", "choices": ["A. 高危区通常约 70 Gy，低至中危亚临床扩散区通常 44–50 Gy 或 54–63 Gy", "B. 所有靶区统一 70 Gy", "C. 低危区通常也要 70 Gy", "D. NCCN 不区分风险区剂量"], "explanation": "NCCN NASO-A/ADV-A 对 concurrent systemic therapy/RT 写明：高危区通常 70 Gy，低至中危亚临床扩散区常用 44–50 Gy 或 54–63 Gy。", "source": "NCCN 2025 NASO-A；NCCN 2025 ADV-A", "evidence_anchors": ["NCCN 2025 NASO-A", "NCCN 2025 ADV-A"], "answer_text": "高危区通常约 70 Gy，低至中危亚临床扩散区通常 44–50 Gy 或 54–63 Gy", "domain": "放疗技术、流程与OAR", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-f93474c6b9f5bd3e1be15002", "question": "根据 CSCO 2025 §3.3/表8，鼻咽原发灶 GTVp 的 PTVp 边界及典型处方剂量最符合的是：", "options": {"A": "GTVp+1 mm；70 Gy/35 F", "B": "GTVp+10 mm；5412 cGy/33 F", "C": "GTVp+5 mm；6006 cGy/33 F", "D": "GTVp+3 mm；6996 cGy/33 F"}, "answer": "D", "choices": ["A. GTVp+1 mm；70 Gy/35 F", "B. GTVp+10 mm；5412 cGy/33 F", "C. GTVp+5 mm；6006 cGy/33 F", "D. GTVp+3 mm；6996 cGy/33 F"], "explanation": "CSCO 2025 靶区勾画及剂量表中，PTVp 为 GTVp+3 mm，典型处方剂量 6996 cGy/33 F。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "GTVp+3 mm；6996 cGy/33 F", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-a586fd415110debd2aa8e9a8", "question": "根据 CSCO 2025 第3.3节/表8，颈部淋巴结 GTVn 的 PTVn 边界及典型处方剂量最符合哪一项？", "options": {"A": "GTVn + 5 mm；6600–6996 cGy/33 F", "B": "GTVn + 1 mm；6006 cGy/33 F", "C": "GTVn + 10 mm；6996 cGy/33 F", "D": "GTVn + 3 mm；5412–5610 cGy/33 F"}, "answer": "A", "choices": ["A. GTVn + 5 mm；6600–6996 cGy/33 F", "B. GTVn + 1 mm；6006 cGy/33 F", "C. GTVn + 10 mm；6996 cGy/33 F", "D. GTVn + 3 mm；5412–5610 cGy/33 F"], "explanation": "CSCO 表8 对 GTVn 的写法非常具体：PTVn = GTVn + 5 mm，典型处方剂量为 6600–6996 cGy/33 F。其余选项分别混入了 PTVp、PTV1/2 或明显不合适的边界设置。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "GTVn + 5 mm；6600–6996 cGy/33 F", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-691f1365c15edd83edef47e6", "question": "根据 CSCO 2025 §3.3/表8，原发灶高危亚临床病灶区 CTVp1 的勾画原则，最符合指南的是：", "options": {"A": "必须统一扩展 15 mm，不能因 OAR 调整", "B": "只对颈部淋巴结定义，不用于原发灶", "C": "GTVp+5–10 mm，通常包括全部鼻咽黏膜；邻近重要OAR时距离可缩小至1 mm", "D": "仅等于 GTVp 本身，不做扩展"}, "answer": "C", "choices": ["A. 必须统一扩展 15 mm，不能因 OAR 调整", "B. 只对颈部淋巴结定义，不用于原发灶", "C. GTVp+5–10 mm，通常包括全部鼻咽黏膜；邻近重要OAR时距离可缩小至1 mm", "D. 仅等于 GTVp 本身，不做扩展"], "explanation": "CSCO 2025 对 CTVp1 的定义为 GTVp+5–10 mm（通常包括全部鼻咽黏膜），若邻近重要 OAR，距离可缩小至 1 mm。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "GTVp+5–10 mm，通常包括全部鼻咽黏膜；邻近重要OAR时距离可缩小至1 mm", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-2c41573415c635b252fc566c", "question": "根据 CSCO 2025 §3.3/表8，原发灶常见路径及 CTV2 设置中，哪一项搭配最符合表格？", "options": {"A": "鼻腔受侵 → 包括翼腭窝和后组筛窦", "B": "翼外肌受侵 → 仅包括眶尖", "C": "咽旁间隙受侵 → 仅包括下颌角", "D": "斜坡受侵 → 仅包括上颌窦前壁"}, "answer": "A", "choices": ["A. 鼻腔受侵 → 包括翼腭窝和后组筛窦", "B. 翼外肌受侵 → 仅包括眶尖", "C. 咽旁间隙受侵 → 仅包括下颌角", "D. 斜坡受侵 → 仅包括上颌窦前壁"], "explanation": "CSCO 2025 CTV2 常见路径设置中，鼻腔受侵时应包括翼腭窝和后组筛窦；其他选项与表中对应关系不符。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "鼻腔受侵 → 包括翼腭窝和后组筛窦", "domain": "初治非转移性成人NPC", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-bdb4c644d8925f64ab3137a5", "question": "根据 CSCO 2025 第3.3节/表8，颈部淋巴结高危亚临床病灶区 CTVn1 的表述，哪一项最符合指南？", "options": {"A": "CTVn1 与 PTVn 完全等同", "B": "CTVn1 只用于咽后淋巴结，不用于颈部淋巴结", "C": "CTVn1 = GTVn + 10 mm；且不参考诱导化疗前范围；PTVn1 5412 cGy/33 F", "D": "CTVn1 = GTVn + 3–5 mm；若接受诱导化疗，应包括化疗前侵犯范围/边界；PTVn1 典型剂量 6006 cGy/33 F"}, "answer": "D", "choices": ["A. CTVn1 与 PTVn 完全等同", "B. CTVn1 只用于咽后淋巴结，不用于颈部淋巴结", "C. CTVn1 = GTVn + 10 mm；且不参考诱导化疗前范围；PTVn1 5412 cGy/33 F", "D. CTVn1 = GTVn + 3–5 mm；若接受诱导化疗，应包括化疗前侵犯范围/边界；PTVn1 典型剂量 6006 cGy/33 F"], "explanation": "这题考的是“高危亚临床区”的定义，而不是 GTV 本体。CSCO 表8 明确写到：CTVn1 通常为 GTVn + 3–5 mm；若已接受诱导化疗，应把化疗前侵犯范围纳入；对应的 PTVn1 典型剂量为 6006 cGy/33 F。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "CTVn1 = GTVn + 3–5 mm；若接受诱导化疗，应包括化疗前侵犯范围/边界；PTVn1 典型剂量 6006 cGy/33 F", "domain": "初治非转移性成人NPC", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-9d865ab8c6ab0b6376ae804e", "question": "根据 CSCO 2025 §3.3 正常组织限量，腮腺的表格型限量写法最符合的是：", "options": {"A": "V60 Gy MAC ≤10 cm²", "B": "Dmean ≤26 Gy，或至少一侧腮腺 V30 Gy ≤50%", "C": "D2% ≤70 Gy", "D": "D0.03cc ≤6 Gy"}, "answer": "B", "choices": ["A. V60 Gy MAC ≤10 cm²", "B. Dmean ≤26 Gy，或至少一侧腮腺 V30 Gy ≤50%", "C. D2% ≤70 Gy", "D. D0.03cc ≤6 Gy"], "explanation": "CSCO 2025 OAR 表中，腮腺限量写法为 Dmean ≤26 Gy，或至少一侧腮腺 V30 Gy ≤50%。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "Dmean ≤26 Gy，或至少一侧腮腺 V30 Gy ≤50%", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-9ed0e831d27934546154e03e", "question": "根据 CSCO 2025 §3.3 正常组织限量，关于甲状腺与臂丛的剂量限制，下列哪项最符合表格？", "options": {"A": "甲状腺 Dmean ≤26 Gy；臂丛 D0.03cc ≤6 Gy", "B": "甲状腺和臂丛均无具体表格限量", "C": "甲状腺 D2% ≤70 Gy；臂丛 Dmean ≤35 Gy", "D": "甲状腺 V50 Gy ≤60% 或 V60 Gy MAC ≤10 cm²；臂丛 PRV D0.03cc ≤66 Gy，MAC ≤70 Gy"}, "answer": "D", "choices": ["A. 甲状腺 Dmean ≤26 Gy；臂丛 D0.03cc ≤6 Gy", "B. 甲状腺和臂丛均无具体表格限量", "C. 甲状腺 D2% ≤70 Gy；臂丛 Dmean ≤35 Gy", "D. 甲状腺 V50 Gy ≤60% 或 V60 Gy MAC ≤10 cm²；臂丛 PRV D0.03cc ≤66 Gy，MAC ≤70 Gy"], "explanation": "CSCO 2025 OAR 表中，甲状腺限量为 V50 Gy ≤60% 或 V60 Gy MAC ≤10 cm²；臂丛为 PRV D0.03cc ≤66 Gy，MAC ≤70 Gy。", "source": "CSCO 2025 §3.3 靶区勾画及正常组织限量；CSCO 2025 表8–9", "evidence_anchors": ["CSCO 2025 §3.3 靶区勾画及正常组织限量", "CSCO 2025 表8–9"], "answer_text": "甲状腺 V50 Gy ≤60% 或 V60 Gy MAC ≤10 cm²；臂丛 PRV D0.03cc ≤66 Gy，MAC ≤70 Gy", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-B. 靶区勾画与剂量处方"} |
| {"id": "l1-sample-f455558fab8b3c0d824a8e04", "question": "根据 CSCO 2025，调强计划剂量验证的常用 Gamma 通过率容差限值为？", "options": {"A": "3%/2 mm、10%阈值、Gamma通过率≥95%", "B": "3%/3 mm，Gamma ≥70%", "C": "2%/1 mm，Gamma ≥100%", "D": "5%/5 mm，Gamma ≥80%"}, "answer": "A", "choices": ["A. 3%/2 mm、10%阈值、Gamma通过率≥95%", "B. 3%/3 mm，Gamma ≥70%", "C. 2%/1 mm，Gamma ≥100%", "D. 5%/5 mm，Gamma ≥80%"], "explanation": "CSCO常用的剂量验证指标是3%/2 mm、10%阈值、Gamma通过率≥95%。这是非常适合出‘放疗流程陷阱题’的稳定数值。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "3%/2 mm、10%阈值、Gamma通过率≥95%", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-C. OAR限量与质控"} |
| {"id": "l1-sample-d94f89a11bf48e14a3e6a2ee", "question": "关于NPC IMRT计划剂量验证，下列哪项最符合CSCO常用容差标准？", "options": {"A": "Gamma 5%/5 mm，≥80%", "B": "Gamma 2%/1 mm，必须100%", "C": "只做机器自检，不需患者特异验证", "D": "Gamma 3%/2 mm、10%阈值，≥95%"}, "answer": "D", "choices": ["A. Gamma 5%/5 mm，≥80%", "B. Gamma 2%/1 mm，必须100%", "C. 只做机器自检，不需患者特异验证", "D. Gamma 3%/2 mm、10%阈值，≥95%"], "explanation": "CSCO放疗流程里常用的计划验证标准是3%/2 mm、10%阈值、Gamma通过率≥95%。这是放疗质控类题最稳定的数字锚点之一。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "Gamma 3%/2 mm、10%阈值，≥95%", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-C. OAR限量与质控"} |
| {"id": "l1-sample-a018685c45a65443be9a5a4f", "question": "根据 CSCO 2025，关于调强计划验证，下列哪项描述最准确？", "options": {"A": "鼻咽癌 IMRT 无需做计划验证", "B": "应包括点剂量验证和剂量分布验证，并鼓励基于患者解剖结构的三维剂量验证", "C": "只需点剂量验证即可", "D": "只需剂量分布验证即可"}, "answer": "B", "choices": ["A. 鼻咽癌 IMRT 无需做计划验证", "B. 应包括点剂量验证和剂量分布验证，并鼓励基于患者解剖结构的三维剂量验证", "C. 只需点剂量验证即可", "D. 只需剂量分布验证即可"], "explanation": "CSCO 对计划验证要求比较完整：既要有点剂量验证，也要有剂量分布验证，并鼓励开展基于患者解剖结构的三维剂量验证。只做其中一部分，不能完整对应指南要求。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "应包括点剂量验证和剂量分布验证，并鼓励基于患者解剖结构的三维剂量验证", "domain": "放疗技术、流程与OAR", "source_type": "CSCO-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-C. OAR限量与质控"} |
| {"id": "l1-sample-625b58f56be5085cb60173f5", "question": "根据 CSCO 2025，同期周疗顺铂常用剂量是？", "options": {"A": "60 mg/m²", "B": "80 mg/m²", "C": "30–40 mg/m²", "D": "20 mg/m²"}, "answer": "C", "choices": ["A. 60 mg/m²", "B. 80 mg/m²", "C. 30–40 mg/m²", "D. 20 mg/m²"], "explanation": "CSCO中，同期周疗顺铂常用剂量是30–40 mg/m²。这个数值在成人与儿童章节都可见到，是高频记忆点。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "30–40 mg/m²", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-26d359131b00e0986df077f5", "question": "根据 CSCO 2025 与 NCCN 2025，同期三周顺铂常用剂量是？", "options": {"A": "120 mg/m²", "B": "80 mg/m²", "C": "75 mg/m²", "D": "100 mg/m²"}, "answer": "D", "choices": ["A. 120 mg/m²", "B. 80 mg/m²", "C. 75 mg/m²", "D. 100 mg/m²"], "explanation": "同期三周顺铂经典剂量是100 mg/m²。它也是NCCN ADV-A/CSCO成人与儿童章节中最稳定的剂量锚点之一。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "100 mg/m²", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-ed354404d6c3a2246c809896", "question": "根据 NCCN 2025，关于再放疗，最符合条件的是：", "options": {"A": "距初次 RT 约 ≥6 个月，能再给至少 60 Gy，且能耐受同步治疗", "B": "只要患者要求即可", "C": "所有复发患者都优先再放疗", "D": "初次 RT 后 2 个月复发即可再放"}, "answer": "A", "choices": ["A. 距初次 RT 约 ≥6 个月，能再给至少 60 Gy，且能耐受同步治疗", "B. 只要患者要求即可", "C. 所有复发患者都优先再放疗", "D. 初次 RT 后 2 个月复发即可再放"], "explanation": "NCCN对再放疗候选者的要求是高度筛选：通常距初次RT约≥6个月、还能接受至少60 Gy、且能耐受同步治疗。它绝不是‘所有复发都先再放疗’。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "距初次 RT 约 ≥6 个月，能再给至少 60 Gy，且能耐受同步治疗", "domain": "复发/转移性成人NPC", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-ee1e187255820d8b50c146d4", "question": "以下哪组条件最符合NCCN对再放疗候选者的描述？", "options": {"A": "距初次RT 2个月、任何体能状态、任意剂量均可", "B": "只要有复发就应首选再放疗", "C": "距初次RT约≥6个月、能够再给至少60 Gy、且可耐受同步治疗", "D": "只看患者意愿，不需考虑既往剂量与器官风险"}, "answer": "C", "choices": ["A. 距初次RT 2个月、任何体能状态、任意剂量均可", "B. 只要有复发就应首选再放疗", "C. 距初次RT约≥6个月、能够再给至少60 Gy、且可耐受同步治疗", "D. 只看患者意愿，不需考虑既往剂量与器官风险"], "explanation": "NCCN把再放疗定义为高度筛选策略，常见条件包括距初次RT约≥6个月、若以治愈为目标通常需要还能给予至少60 Gy，并且患者能耐受同步治疗。", "source": "NCCN 2025 ADV-3；NCCN 2025 ADV-A（reirradiation principles）", "evidence_anchors": ["NCCN 2025 ADV-3", "NCCN 2025 ADV-A（reirradiation principles）"], "answer_text": "距初次RT约≥6个月、能够再给至少60 Gy、且可耐受同步治疗", "domain": "初治非转移性成人NPC", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-6c8b84316a2f3df4acfeca67", "question": "根据 NCCN 2025 ADV-A/NASO-A 脚注，当鼻咽癌放疗总剂量 >70 Gy 时，部分专家建议如何微调分割方式以减少毒性？", "options": {"A": "一律改为每周一次大分割", "B": "总剂量 >70 Gy 时不需要任何分割调整", "C": "对至少部分疗程轻度调整为 <2.0 Gy/fraction", "D": "统一改为 >2.2 Gy/fraction"}, "answer": "C", "choices": ["A. 一律改为每周一次大分割", "B. 总剂量 >70 Gy 时不需要任何分割调整", "C. 对至少部分疗程轻度调整为 <2.0 Gy/fraction", "D. 统一改为 >2.2 Gy/fraction"], "explanation": "NCCN 脚注明确写到：对于 >70 Gy 的剂量，一些临床医生认为应对分割方式做轻度调整，例如至少部分疗程采用 <2.0 Gy/fraction，以减少毒性。", "source": "NCCN 2025 NASO-A；NCCN 2025 ADV-A", "evidence_anchors": ["NCCN 2025 NASO-A", "NCCN 2025 ADV-A"], "answer_text": "对至少部分疗程轻度调整为 <2.0 Gy/fraction", "domain": "放疗技术、流程与OAR", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-f6f8aee4988b03cabf491aa4", "question": "根据 NCCN 2025 ADV-A/NASO-A 脚注，关于 >70 Gy 时的额外加量（boost），哪项最符合指南脚注？", "options": {"A": "可根据临床情况再加 2–3 次照射", "B": "绝对禁止任何额外加量", "C": "额外加量只允许在儿童中进行", "D": "必须固定追加 10 次照射"}, "answer": "A", "choices": ["A. 可根据临床情况再加 2–3 次照射", "B. 绝对禁止任何额外加量", "C. 额外加量只允许在儿童中进行", "D. 必须固定追加 10 次照射"], "explanation": "NCCN 脚注指出：在某些临床情况下，可额外增加 2–3 次照射。", "source": "NCCN 2025 NASO-A；NCCN 2025 ADV-A", "evidence_anchors": ["NCCN 2025 NASO-A", "NCCN 2025 ADV-A"], "answer_text": "可根据临床情况再加 2–3 次照射", "domain": "放疗技术、流程与OAR", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-1222f1d82f1173910c61bcd3", "question": "根据 NCCN 2025 ADV-A/NASO-A，在何种情况下可考虑 proton therapy？", "options": {"A": "所有鼻咽癌患者一律优先 proton", "B": "只用于化疗失败后的姑息放疗", "C": "当光子放疗无法满足正常组织限量，或会影响标准肿瘤/术后体积剂量时", "D": "仅 T1N0 才可考虑 proton"}, "answer": "C", "choices": ["A. 所有鼻咽癌患者一律优先 proton", "B. 只用于化疗失败后的姑息放疗", "C. 当光子放疗无法满足正常组织限量，或会影响标准肿瘤/术后体积剂量时", "D. 仅 T1N0 才可考虑 proton"], "explanation": "NCCN 明确写到：当 photon-based therapy 不能满足 normal tissue constraints，或 compromise 标准肿瘤/术后体积剂量时，可考虑 proton therapy。", "source": "NCCN 2025 NASO-A；NCCN 2025 ADV-A", "evidence_anchors": ["NCCN 2025 NASO-A", "NCCN 2025 ADV-A"], "answer_text": "当光子放疗无法满足正常组织限量，或会影响标准肿瘤/术后体积剂量时", "domain": "放疗技术、流程与OAR", "source_type": "NCCN-only", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-430242228049fba7e9b5196e", "question": "根据 NCCN 2025 ADV-A，对既往放疗后拟行再放疗的患者，OAR 可接受剂量最应依据下列哪项综合判断？", "options": {"A": "原始放疗距今的时间间隔、拟纳入体积、患者预期寿命及DVH分析", "B": "只看是否能接受同步化疗", "C": "只看患者年龄", "D": "只看当前CT上的肿瘤大小"}, "answer": "A", "choices": ["A. 原始放疗距今的时间间隔、拟纳入体积、患者预期寿命及DVH分析", "B. 只看是否能接受同步化疗", "C. 只看患者年龄", "D. 只看当前CT上的肿瘤大小"], "explanation": "NCCN ADV-A 明确指出，再放疗时 OAR 毒性风险需结合原放疗时间间隔、拟纳入体积、患者预期寿命，并仔细分析 DVH。", "source": "NCCN 2025 ADV-A（reirradiation principles）；CSCO 2025 §3.3 正常组织限量（对照理解）", "evidence_anchors": ["NCCN 2025 ADV-A（reirradiation principles）", "CSCO 2025 §3.3 正常组织限量（对照理解）"], "answer_text": "原始放疗距今的时间间隔、拟纳入体积、患者预期寿命及DVH分析", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "V. 放疗实施、靶区与OAR", "scope_minor": "V-D. 再放疗技术与特殊放疗情境"} |
| {"id": "l1-sample-0f29c460d042f7ca1c4c8a86", "question": "根据 CSCO 2025，关于外周血EBV抗体/EBV DNA在鼻咽癌中的应用，以下哪项最符合指南表述？", "options": {"A": "阴性结果基本可以排除鼻咽癌", "B": "主要只对角化型鼻咽癌具有临床价值", "C": "仅在治疗后随访时有意义，初诊价值有限", "D": "阳性结果可辅助诊断和风险评估，但阴性不能完全排除疾病"}, "answer": "D", "choices": ["A. 阴性结果基本可以排除鼻咽癌", "B. 主要只对角化型鼻咽癌具有临床价值", "C. 仅在治疗后随访时有意义，初诊价值有限", "D. 阳性结果可辅助诊断和风险评估，但阴性不能完全排除疾病"], "explanation": "外周血EBV抗体和EBV DNA可用于鼻咽癌筛查、辅助诊断和风险评估，但阴性结果并不能完全排除疾病，因此不能把它们当作排除性标准。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "阳性结果可辅助诊断和风险评估，但阴性不能完全排除疾病", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-4f61de7104d5225aa742cc96", "question": "根据 NCCN 2025，T2N0/T0(EBV+)–2N1/T3N0 路径中提到的 high-risk features 包括？", "options": {"A": "吸烟史", "B": "年龄 >60", "C": "男性", "D": "bulky tumor volume 和高 serum EBV DNA"}, "answer": "D", "choices": ["A. 吸烟史", "B. 年龄 >60", "C. 男性", "D. bulky tumor volume 和高 serum EBV DNA"], "explanation": "NCCN在这一路径里点名的high-risk features就是bulky tumor volume和高血清EBV DNA。不是年龄、性别或吸烟史。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "bulky tumor volume 和高 serum EBV DNA", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-c1db498befc328a0c3f3698a", "question": "根据 NCCN 2025，对 T0(EBV+)–2N1M0 或 T3N0M0，最符合指南的是：", "options": {"A": "RT alone regardless of risk", "B": "IC→CCRT 为 preferred category 1", "C": "concurrent systemic therapy/RT；若有 high-risk features，再考虑 induction 或 adjuvant", "D": "pembrolizumab 单药"}, "answer": "C", "choices": ["A. RT alone regardless of risk", "B. IC→CCRT 为 preferred category 1", "C. concurrent systemic therapy/RT；若有 high-risk features，再考虑 induction 或 adjuvant", "D. pembrolizumab 单药"], "explanation": "NCCN对T0(EBV+)–2N1M0或T3N0M0的核心是concurrent systemic therapy/RT；若有high-risk features，再考虑induction或adjuvant。这正是上一版最关键的修错点。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "concurrent systemic therapy/RT；若有 high-risk features，再考虑 induction 或 adjuvant", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-a9d0b4ed9ace8ae981867825", "question": "根据 NCCN 2025，对 EBV-associated disease 且 T4,N1–3 或 any T,N2–3，可作为 useful in certain circumstances 的方案是？", "options": {"A": "nivolumab 单药维持", "B": "cisplatin + RT 后 capecitabine ± prior induction", "C": "直接手术", "D": "methotrexate 单药"}, "answer": "B", "choices": ["A. nivolumab 单药维持", "B. cisplatin + RT 后 capecitabine ± prior induction", "C. 直接手术", "D. methotrexate 单药"], "explanation": "NCCN把‘cisplatin + RT followed by capecitabine ± induction’列为EBV-associated且T4N1–3或任何T,N2–3的useful in certain circumstances。并不是适用于所有分层。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "cisplatin + RT 后 capecitabine ± prior induction", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-e6e7c258257025ccffcd9475", "question": "52岁男性，初诊鼻咽癌 cT2N0M0，MRI示原发灶体积偏大，血浆EBV DNA 12000 copies/mL。按NCCN，最符合指南的初始治疗是？", "options": {"A": "直接进入RM-NPC一线免疫联合", "B": "definitive RT，可考虑加 concurrent systemic therapy", "C": "单纯definitive RT", "D": "IC→CCRT 为唯一首选"}, "answer": "B", "choices": ["A. 直接进入RM-NPC一线免疫联合", "B. definitive RT，可考虑加 concurrent systemic therapy", "C. 单纯definitive RT", "D. IC→CCRT 为唯一首选"], "explanation": "NCCN对T2N0M0的标准是definitive RT；若存在high-risk features，如bulky tumor volume或高血清EBV DNA，可在RT基础上考虑加同期系统治疗。它并没有把所有T2N0一律升级为IC→CCRT。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "definitive RT，可考虑加 concurrent systemic therapy", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-fdd0075cfa0cf875605b7139", "question": "50岁患者，T0(EBV+)N1M0，EBV DNA显著升高。按NCCN，最符合指南主路径的表述是？", "options": {"A": "IC→CCRT 为preferred category 1", "B": "PD-1单药联合RT", "C": "concurrent systemic therapy/RT；若有high-risk features，再考虑induction或adjuvant", "D": "单纯RT"}, "answer": "C", "choices": ["A. IC→CCRT 为preferred category 1", "B. PD-1单药联合RT", "C. concurrent systemic therapy/RT；若有high-risk features，再考虑induction或adjuvant", "D. 单纯RT"], "explanation": "NCCN把T0(EBV+)–2N1M0 / T3N0M0 与更高危的N2–3或T3N1–3/T4人群分开：这组的主路径是concurrent systemic therapy/RT，若有high-risk features再考虑加前/后序治疗。", "source": "CSCO 2025 §2.3 分期【注释】；AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）", "evidence_anchors": ["CSCO 2025 §2.3 分期【注释】", "AJCC/UICC 第9版（Pan et al., JAMA Oncol 2024）"], "answer_text": "concurrent systemic therapy/RT；若有high-risk features，再考虑induction或adjuvant", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-926dc3469d5a0a3bdb65bd01", "question": "根据 CSCO 2025，下列哪组血清学指标组合已被前瞻性筛查研究用于提高鼻咽癌早诊率？", "options": {"A": "TGAb + TPOAb", "B": "VCA/IgA + EBNA1/IgA", "C": "AFP + PIVKA-II", "D": "CEA + CA19-9"}, "answer": "B", "choices": ["A. TGAb + TPOAb", "B. VCA/IgA + EBNA1/IgA", "C. AFP + PIVKA-II", "D. CEA + CA19-9"], "explanation": "CSCO指出VCA/IgA与EBNA1/IgA组合筛查可显著提高早诊率。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "VCA/IgA + EBNA1/IgA", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-1d530059ecf79c21bee4a7aa", "question": "根据 CSCO 2025，血浆EBV DNA用于鼻咽癌筛查时，最准确的表述是：", "options": {"A": "灵敏度和特异度可很高，但目前缺乏统一标准化流程", "B": "灵敏度和特异度都很低", "C": "阴性即可排除鼻咽癌", "D": "只能用于治疗后监测"}, "answer": "A", "choices": ["A. 灵敏度和特异度可很高，但目前缺乏统一标准化流程", "B. 灵敏度和特异度都很低", "C. 阴性即可排除鼻咽癌", "D. 只能用于治疗后监测"], "explanation": "CSCO指出血浆EBV DNA筛查效能高，但标准化仍不足。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "灵敏度和特异度可很高，但目前缺乏统一标准化流程", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-7be36d076e9260f428a54209", "question": "根据 NCCN 2025，血浆/血清EBV DNA最常用的PCR扩增靶点之一是：", "options": {"A": "TERT启动子", "B": "BamHI-W", "C": "KRAS exon 2", "D": "BCR-ABL1"}, "answer": "B", "choices": ["A. TERT启动子", "B. BamHI-W", "C. KRAS exon 2", "D. BCR-ABL1"], "explanation": "NCCN脚注明确提到EBV DNA可用BamHI-W等序列作为PCR靶点。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "BamHI-W", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-5bff88ac5b674dc2c026a33d", "question": "根据 CSCO 2025，关于 EBV 相关标志物筛查，下列最准确的是：", "options": {"A": "目前已有大规模头对头研究证明 EBV DNA 绝对优于血清抗体", "B": "目前仍缺乏大规模头对头研究明确 EBV DNA 与血清 IgA 抗体谁更优", "C": "二者均已被证实完全无效", "D": "目前已有大规模头对头研究证明血清抗体绝对优于 EBV DNA"}, "answer": "B", "choices": ["A. 目前已有大规模头对头研究证明 EBV DNA 绝对优于血清抗体", "B. 目前仍缺乏大规模头对头研究明确 EBV DNA 与血清 IgA 抗体谁更优", "C. 二者均已被证实完全无效", "D. 目前已有大规模头对头研究证明血清抗体绝对优于 EBV DNA"], "explanation": "CSCO 2025 指出目前仍缺乏大规模头对头研究，明确血浆 EBV DNA 与血清 IgA 抗体孰优。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "目前仍缺乏大规模头对头研究明确 EBV DNA 与血清 IgA 抗体谁更优", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-933f7a86537f42eb7bbdefe6", "question": "根据 CSCO 2025，关于鼻咽拭子/唾液甲基化或 miRNA-BARTs 等新型 EBV 相关检测的定位，更符合指南的是：", "options": {"A": "已成为所有人群筛查的标准常规", "B": "仅用于术后病理会诊", "C": "具有潜力，但仍缺乏足够大样本人群研究验证", "D": "已完全取代 EBER 和血浆 EBV DNA"}, "answer": "C", "choices": ["A. 已成为所有人群筛查的标准常规", "B. 仅用于术后病理会诊", "C. 具有潜力，但仍缺乏足够大样本人群研究验证", "D. 已完全取代 EBER 和血浆 EBV DNA"], "explanation": "CSCO 将鼻咽拭子甲基化、miRNA-BARTs 等视为有潜力方向，但尚未完全标准化进入常规筛查。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "具有潜力，但仍缺乏足够大样本人群研究验证", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-af4bb3441f5704214d6af714", "question": "根据 CSCO 2025，关于鼻咽癌筛查中的新型血清学分子标志物，下列哪项更符合指南注释？", "options": {"A": "P85-Ab 只用于治疗后疗效监测", "B": "抗BNLF2b总抗体（P85-Ab）被提及为筛查表现优异的新型标志物之一", "C": "P85-Ab 已被完全取代并不再推荐讨论", "D": "P85-Ab 只用于非角化型儿童病例"}, "answer": "B", "choices": ["A. P85-Ab 只用于治疗后疗效监测", "B. 抗BNLF2b总抗体（P85-Ab）被提及为筛查表现优异的新型标志物之一", "C. P85-Ab 已被完全取代并不再推荐讨论", "D. P85-Ab 只用于非角化型儿童病例"], "explanation": "CSCO 2024/2025 注释提到抗BNLF2b总抗体（P85-Ab）在筛查中的表现优异，是值得关注的新型血清学标志物。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "抗BNLF2b总抗体（P85-Ab）被提及为筛查表现优异的新型标志物之一", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-266a84792400324f200eeadd", "question": "根据 CSCO 2025，关于鼻咽拭子/唾液甲基化、miRNA-BARTs 等新型 EBV 相关检测，最符合指南的是：", "options": {"A": "属于有潜力的方向，但仍需更多大样本人群研究验证", "B": "已成为所有高发区人群的标准常规筛查手段", "C": "只能用于病理切片复核", "D": "已经完全取代血浆 EBV DNA"}, "answer": "A", "choices": ["A. 属于有潜力的方向，但仍需更多大样本人群研究验证", "B. 已成为所有高发区人群的标准常规筛查手段", "C. 只能用于病理切片复核", "D. 已经完全取代血浆 EBV DNA"], "explanation": "CSCO 2025 将鼻咽拭子/唾液甲基化和 miRNA-BARTs 视为有潜力方向，但尚未完全标准化进入常规应用。", "source": "CSCO 2025 §11.1 筛查与诊断；NCCN 2025 NASO-1", "evidence_anchors": ["CSCO 2025 §11.1 筛查与诊断", "NCCN 2025 NASO-1"], "answer_text": "属于有潜力的方向，但仍需更多大样本人群研究验证", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-A. 筛查与早诊标志物"} |
| {"id": "l1-sample-213b41f339bb7513cfe54539", "question": "根据 CSCO 2025，对 T2N0 且无 EBV DNA ≥4000 copies/mL、无 bulky 等不良因素的患者，优先推荐哪一项？", "options": {"A": "单纯放疗", "B": "同期放化疗", "C": "诱导化疗后同期放化疗", "D": "放疗后常规辅助化疗"}, "answer": "A", "choices": ["A. 单纯放疗", "B. 同期放化疗", "C. 诱导化疗后同期放化疗", "D. 放疗后常规辅助化疗"], "explanation": "这题考的是“有条件降阶”。对 T2N0 且无高 EBV DNA、无 bulky 等不良因素者，CSCO 允许优先选择单纯放疗；并不是所有 T2N0 都必须进入同步或诱导强化路径。", "source": "CSCO 2025 表10（T2N0 分层推荐）+ 表11（初治化疗模式）；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 表10（T2N0 分层推荐）+ 表11（初治化疗模式）", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "单纯放疗", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-1d97c2206e933dad43d4dffb", "question": "根据 CSCO 2025，对 T1–2N1 且无 ≥3 cm 淋巴结、无 Ⅳ/ⅤB 区转移、无包膜外侵、无高 EBV DNA 的患者，可考虑哪一项？", "options": {"A": "一律诱导化疗后同期放化疗", "B": "一律 PD-1 联合放疗", "C": "单纯放疗", "D": "一律同期放化疗后辅助治疗"}, "answer": "C", "choices": ["A. 一律诱导化疗后同期放化疗", "B. 一律 PD-1 联合放疗", "C. 单纯放疗", "D. 一律同期放化疗后辅助治疗"], "explanation": "这题考察的是 N1 内部的再分层。CSCO 明确允许对低危 T1–2N1 患者考虑单纯放疗；只有合并明显不良因素时，才更倾向升级至同期放化疗或更强化方案。", "source": "CSCO 2025 表10（T1–2N1 分层推荐）+ 表11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 表10（T1–2N1 分层推荐）+ 表11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "单纯放疗", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-7ef9b84f8d310e4d5063a677", "question": "根据 CSCO 2025，T3N0 在无 EBV DNA ≥4000 copies/mL、无 bulky 等不良因素时，可考虑：", "options": {"A": "必须 CCRT", "B": "必须 IC→CCRT", "C": "单纯放疗", "D": "必须辅助化疗"}, "answer": "C", "choices": ["A. 必须 CCRT", "B. 必须 IC→CCRT", "C. 单纯放疗", "D. 必须辅助化疗"], "explanation": "CSCO中，T3N0在没有高EBV DNA或bulky等不良因素时可考虑单纯放疗。它并不是绝对必须做IC或CCRT的人群。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "单纯放疗", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-eeb675f9f04b1178f18dd0f8", "question": "根据 NCCN 2025，对 T3N1–3M0 / T4N0–3M0 / T0(EBV+)–2N2–3M0，主路径是：", "options": {"A": "PD-1 单药", "B": "surgery first", "C": "RT alone", "D": "clinical trial 或 IC→CCRT（preferred, category 1）或 CCRT→adjuvant"}, "answer": "D", "choices": ["A. PD-1 单药", "B. surgery first", "C. RT alone", "D. clinical trial 或 IC→CCRT（preferred, category 1）或 CCRT→adjuvant"], "explanation": "更高危的T3N1–3/T4N0–3/T0(EBV+)–2N2–3在NCCN中可走clinical trial、或IC→CCRT（preferred，category 1）、或CCRT→辅助等路径。不能把这一组与T3N0混在一起。", "source": "CSCO 2025 §5（早期和局部晚期药物治疗）；表10–11；NCCN 2025 NASO-2、NASO-B", "evidence_anchors": ["CSCO 2025 §5（早期和局部晚期药物治疗）", "表10–11", "NCCN 2025 NASO-2、NASO-B"], "answer_text": "clinical trial 或 IC→CCRT（preferred, category 1）或 CCRT→adjuvant", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-101c19841957e2cd84f3f6cb", "question": "45岁男性，cT1N1M0，单侧II区淋巴结 1.8 cm，无IV/VB区转移，无包膜外侵，EBV DNA 1800 copies/mL。按CSCO，更符合指南的治疗是？", "options": {"A": "同期放化疗+节拍卡培他滨", "B": "同期放化疗", "C": "诱导化疗+同期放化疗", "D": "单纯放疗"}, "answer": "D", "choices": ["A. 同期放化疗+节拍卡培他滨", "B. 同期放化疗", "C. 诱导化疗+同期放化疗", "D. 单纯放疗"], "explanation": "CSCO允许T1–2N1且无≥3 cm淋巴结、无IV/VB区转移、无包膜外侵、无高EBV DNA时考虑单纯放疗。这个病例正是用于区分‘N1不等于必定并放’的边界条件。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "单纯放疗", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-ff946b492579bd19ab26122c", "question": "48岁男性，cT2N1M0，单侧VB区淋巴结转移，最大短径2.4 cm，EBV DNA 6200 copies/mL。按CSCO，更符合指南的治疗是？", "options": {"A": "同期放化疗", "B": "单纯放疗", "C": "只需诱导化疗", "D": "仅随访观察"}, "answer": "A", "choices": ["A. 同期放化疗", "B. 单纯放疗", "C. 只需诱导化疗", "D. 仅随访观察"], "explanation": "虽然仍是T2N1，但病例已出现不良因素（VB区转移和高EBV DNA），不再适合按低风险T1–2N1处理。CSCO对此更倾向同期放化疗，而不是单纯放疗。", "source": "CSCO 2025 §6–9；表13（转移性治疗）及相关注释；NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B", "evidence_anchors": ["CSCO 2025 §6–9", "表13（转移性治疗）及相关注释", "NCCN 2025 NASO-3、ADV-3/ADV-A、NASO-B"], "answer_text": "同期放化疗", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-b82c2df424484eb33f38b20a", "question": "根据 CSCO 2025，下列哪项更符合鼻咽癌 EBV 风险预测的认识？", "options": {"A": "治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈正相关", "B": "EBV DNA 只在儿童患者中有意义", "C": "治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈负相关", "D": "EBV DNA 仅用于病理分型，不用于风险评估"}, "answer": "A", "choices": ["A. 治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈正相关", "B. EBV DNA 只在儿童患者中有意义", "C. 治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈负相关", "D. EBV DNA 仅用于病理分型，不用于风险评估"], "explanation": "CSCO 2025 延续并强化了治疗前血浆 EBV DNA 与肿瘤负荷、疾病分期、疾病进展风险正相关的认识。", "source": "CSCO 2025 §11.2 风险预测；CSCO 2025 §2.3 分期注释", "evidence_anchors": ["CSCO 2025 §11.2 风险预测", "CSCO 2025 §2.3 分期注释"], "answer_text": "治疗前血浆 EBV DNA 与肿瘤负荷、分期和进展风险呈正相关", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-d0742f9a2ccbe1aa883c0366", "question": "根据 CSCO 2025，对“不超过一线治疗失败”且 EBV 相关的 RM-NPC，可考虑哪一项联合方案？", "options": {"A": "特瑞普利单抗 + 卡培他滨", "B": "卡瑞利珠单抗 + 阿帕替尼", "C": "纳武利尤单抗 + 伊匹木单抗", "D": "帕博利珠单抗 + 西妥昔单抗"}, "answer": "C", "choices": ["A. 特瑞普利单抗 + 卡培他滨", "B. 卡瑞利珠单抗 + 阿帕替尼", "C. 纳武利尤单抗 + 伊匹木单抗", "D. 帕博利珠单抗 + 西妥昔单抗"], "explanation": "CSCO 仍保留 nivolumab 3 mg/kg q2w + ipilimumab 1 mg/kg q6w 这一选项，用于不超过一线失败的 EBV 相关 RM-NPC。其余选项要么不是该特定人群/线次的表格方案，要么并未被指南在这一位置列为对应组合。", "source": "CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13；CSCO 2025 §9 鼻咽癌的免疫治疗；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §6 转移性鼻咽癌的治疗；表12–13", "CSCO 2025 §9 鼻咽癌的免疫治疗", "NCCN 2025 NASO-B"], "answer_text": "纳武利尤单抗 + 伊匹木单抗", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-21b5cf47e0ee678362d7a84f", "question": "根据 CSCO 2025，关于血浆 EBV DNA 与 TNM 分期的关系，更准确的表述是：", "options": {"A": "EBV DNA 只用于儿童病例", "B": "TNM 已足够，EBV DNA 无额外价值", "C": "治疗前血浆 EBV DNA 联合 TNM 可进一步提高风险/预后分层效能", "D": "二者互不相关"}, "answer": "C", "choices": ["A. EBV DNA 只用于儿童病例", "B. TNM 已足够，EBV DNA 无额外价值", "C. 治疗前血浆 EBV DNA 联合 TNM 可进一步提高风险/预后分层效能", "D. 二者互不相关"], "explanation": "CSCO 2025 延续并强化了 EBV DNA 与 TNM 联合可提高风险预测与预后分层能力的认识。", "source": "CSCO 2025 §11.2 风险预测；CSCO 2025 §2.3 分期注释", "evidence_anchors": ["CSCO 2025 §11.2 风险预测", "CSCO 2025 §2.3 分期注释"], "answer_text": "治疗前血浆 EBV DNA 联合 TNM 可进一步提高风险/预后分层效能", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-70d3819f705a08a4ccec12af", "question": "根据 CSCO 2025 表10，对 T1–2N1 且无淋巴结≥3 cm、无Ⅳ/ⅤB区转移、无包膜外侵、无 EBV DNA≥4000 的患者，最符合表格的是：", "options": {"A": "必须节拍辅助卡培他滨", "B": "单纯放疗可列为 1A类；同期放化疗为 2A类", "C": "必须诱导化疗 + 同期放化疗", "D": "只能同步免疫治疗"}, "answer": "B", "choices": ["A. 必须节拍辅助卡培他滨", "B. 单纯放疗可列为 1A类；同期放化疗为 2A类", "C. 必须诱导化疗 + 同期放化疗", "D. 只能同步免疫治疗"], "explanation": "表10对 T1–2N1M0 写法为：同期放化疗（2A类）；若无上述不良因素，单纯放疗可列为 1A类。", "source": "CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11；NCCN 2025 NASO-2；NCCN 2025 NASO-B", "evidence_anchors": ["CSCO 2025 §5 早期和局部晚期鼻咽癌的药物治疗；表10–11", "NCCN 2025 NASO-2", "NCCN 2025 NASO-B"], "answer_text": "单纯放疗可列为 1A类；同期放化疗为 2A类", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-B. 预后分层与EBV驱动治疗决策"} |
| {"id": "l1-sample-bbe6b78bc348bcf514092486", "question": "根据 CSCO 2025，在初治完成后，若借助血浆 EBV DNA 辅助判断失败模式，下列哪项最符合现有证据？", "options": {"A": "对失败模式判断基本没有临床价值", "B": "对远处转移的诊断准确性通常高于对复发的诊断", "C": "对区域复发的诊断准确性最高", "D": "对局部复发的诊断准确性最高"}, "answer": "B", "choices": ["A. 对失败模式判断基本没有临床价值", "B. 对远处转移的诊断准确性通常高于对复发的诊断", "C. 对区域复发的诊断准确性最高", "D. 对局部复发的诊断准确性最高"], "explanation": "CSCO 汇总的证据显示，血浆 EBV DNA 对初治后失败模式判断有价值，但其对远处转移的诊断准确性通常高于对局部/区域复发的判断。把它误记为“对局部复发最敏感”是常见错误。", "source": "CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断；NCCN 2025 NASO-1 Workup", "evidence_anchors": ["CSCO 2025 §2.1 影像诊断、§2.2 病理学诊断", "NCCN 2025 NASO-1 Workup"], "answer_text": "对远处转移的诊断准确性通常高于对复发的诊断", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-C. 疗效监测与复发预警"} |
| {"id": "l1-sample-3a44e792dbb7a3af6689a3ad", "question": "治疗后常规影像未见明确病灶，但血浆EBV DNA持续进行性升高。按CSCO，更合理的下一步是？", "options": {"A": "仅观察，等待EBV DNA自然波动", "B": "立即开始二线免疫", "C": "直接诊断远处转移", "D": "进一步结合PET/CT检查"}, "answer": "D", "choices": ["A. 仅观察，等待EBV DNA自然波动", "B. 立即开始二线免疫", "C. 直接诊断远处转移", "D. 进一步结合PET/CT检查"], "explanation": "CSCO建议，对治疗后EBV DNA持续或进行性升高而常规影像无阳性发现者，可进一步结合PET/CT检查。这是EBV监测与影像整合应用的典型场景。", "source": "CSCO 2025 §11.3 疗效监测、§11.4 随访；CSCO 2025 §13 随访；表22", "evidence_anchors": ["CSCO 2025 §11.3 疗效监测、§11.4 随访", "CSCO 2025 §13 随访；表22"], "answer_text": "进一步结合PET/CT检查", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-C. 疗效监测与复发预警"} |
| {"id": "l1-sample-489b27aef77bf52d3c576397", "question": "根据 NCCN 2025，对EBER阳性鼻咽癌，随访中可考虑：", "options": {"A": "固定每月脑脊液检测", "B": "常规骨髓活检", "C": "EBV DNA监测", "D": "每周肺功能"}, "answer": "C", "choices": ["A. 固定每月脑脊液检测", "B. 常规骨髓活检", "C. EBV DNA监测", "D. 每周肺功能"], "explanation": "NCCN随访原则提到对EBER阳性鼻咽癌可考虑EBV DNA monitoring。", "source": "CSCO 2025 §11.3 疗效监测、§11.4 随访；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §11.3 疗效监测、§11.4 随访", "NCCN 2025 FOLL-A"], "answer_text": "EBV DNA监测", "domain": "EBV相关分子标志物", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-C. 疗效监测与复发预警"} |
| {"id": "l1-sample-f14303ee1bbd0a76c55acc86", "question": "根据 CSCO 2025，关于鼻咽癌EBV相关检测，以下哪项正确？", "options": {"A": "只在复发时有用", "B": "仅儿童有意义", "C": "若EBV抗体和EBV DNA均阴性，就可排除鼻咽癌", "D": "阴性结果不能排除鼻咽癌"}, "answer": "D", "choices": ["A. 只在复发时有用", "B. 仅儿童有意义", "C. 若EBV抗体和EBV DNA均阴性，就可排除鼻咽癌", "D. 阴性结果不能排除鼻咽癌"], "explanation": "CSCO明确提醒：即便这些指标均阴性，也不能排除NPC。", "source": "CSCO 2025 §11.2 风险预测；CSCO 2025 §2.3 分期注释", "evidence_anchors": ["CSCO 2025 §11.2 风险预测", "CSCO 2025 §2.3 分期注释"], "answer_text": "阴性结果不能排除鼻咽癌", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-D. 检测方法学与新型标志物"} |
| {"id": "l1-sample-009666bccacfbceb4a2d9bcc", "question": "根据 CSCO 2025，关于血浆EBV DNA的标准化检测，最符合现状的是：", "options": {"A": "仅中国有统一国家标准", "B": "目前尚无国际公认统一标准化流程", "C": "PCR已完全被NGS淘汰", "D": "已存在国际公认统一流程"}, "answer": "B", "choices": ["A. 仅中国有统一国家标准", "B. 目前尚无国际公认统一标准化流程", "C. PCR已完全被NGS淘汰", "D. 已存在国际公认统一流程"], "explanation": "CSCO指出目前尚无国际公认的EBV DNA标准化检测流程。", "source": "CSCO 2025 §11.2 风险预测；CSCO 2025 §2.3 分期注释", "evidence_anchors": ["CSCO 2025 §11.2 风险预测", "CSCO 2025 §2.3 分期注释"], "answer_text": "目前尚无国际公认统一标准化流程", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-D. 检测方法学与新型标志物"} |
| {"id": "l1-sample-26a46059cf04f98d71a932e4", "question": "根据 CSCO 2025，关于 EBV DNA 实验室标准化检测，下列哪项最符合现有指南的“深度细节”要求？", "options": {"A": "不需要国家药监部门批准的检测试剂", "B": "EBV DNA 定量只需唾液样本，不需血浆", "C": "样本类型通常为外周血，推荐 EDTA 抗凝，且实验室应分试剂准备区、标本制备区和扩增区", "D": "任何样本、任何操作区设置都无差异"}, "answer": "C", "choices": ["A. 不需要国家药监部门批准的检测试剂", "B. EBV DNA 定量只需唾液样本，不需血浆", "C. 样本类型通常为外周血，推荐 EDTA 抗凝，且实验室应分试剂准备区、标本制备区和扩增区", "D. 任何样本、任何操作区设置都无差异"], "explanation": "CSCO 2023/2025 在 EBV DNA 标准化检测部分写得很细，包括外周血 EDTA 样本、样本时限、三区分区管理及有证试剂等要求。", "source": "CSCO 2025 §11.5 血浆EBV DNA的标准化检测", "evidence_anchors": ["CSCO 2025 §11.5 血浆EBV DNA的标准化检测"], "answer_text": "样本类型通常为外周血，推荐 EDTA 抗凝，且实验室应分试剂准备区、标本制备区和扩增区", "domain": "EBV相关分子标志物", "source_type": "CSCO-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-D. 检测方法学与新型标志物"} |
| {"id": "l1-sample-f8fabb29bfde8e7070350371", "question": "根据 NCCN 2025 NASO-B，在鼻咽癌系统治疗开始前，指南脚注建议至少补做哪些生物标志物检测？", "options": {"A": "仅 BRAF 和 KRAS", "B": "仅 MSI", "C": "至少 CPS 和 TMB", "D": "仅 HER2 和 EGFR"}, "answer": "C", "choices": ["A. 仅 BRAF 和 KRAS", "B. 仅 MSI", "C. 至少 CPS 和 TMB", "D. 仅 HER2 和 EGFR"], "explanation": "NCCN NASO-B 明确写到：在治疗前应使用 NGS profiling 和其他适当的生物标志物检测，至少检测 CPS 和 TMB（category 2B）。", "source": "NCCN 2025 NASO-B（系统治疗前 CPS/TMB 脚注）", "evidence_anchors": ["NCCN 2025 NASO-B（系统治疗前 CPS/TMB 脚注）"], "answer_text": "至少 CPS 和 TMB", "domain": "儿童鼻咽癌", "source_type": "NCCN-only", "scope_major": "VI. EBV与分子标志物", "scope_minor": "VI-D. 检测方法学与新型标志物"} |
| {"id": "l1-sample-3547d2f3f7753af578fe38e2", "question": "根据 CSCO 2025 儿童章节，关于非转移性儿童鼻咽癌诱导化疗推荐等级，哪一项最符合指南表述？", "options": {"A": "GP 与 TPF 同属 2A类，PF 降为 3类", "B": "所有成人 1A 级诱导方案在儿童中均自动沿用为 2A类", "C": "PF、TPF、TP 均为 2A类，而 GP 不属于 2A类", "D": "只有 PF 属于 2A类，TPF 和 TP 均为 3类"}, "answer": "C", "choices": ["A. GP 与 TPF 同属 2A类，PF 降为 3类", "B. 所有成人 1A 级诱导方案在儿童中均自动沿用为 2A类", "C. PF、TPF、TP 均为 2A类，而 GP 不属于 2A类", "D. 只有 PF 属于 2A类，TPF 和 TP 均为 3类"], "explanation": "儿童章节的证据分层不能直接照搬成人。CSCO 2025 将 PF、TPF、TP 列为儿童非转移性 NPC 诱导化疗的 2A类，而 GP 并未进入这一层级。", "source": "CSCO 2025 第10.3节非转移儿童鼻咽癌治疗（页130起）+ 表17–18", "evidence_anchors": ["CSCO 2025 第10.3节非转移儿童鼻咽癌治疗（页130起）+ 表17–18"], "answer_text": "PF、TPF、TP 均为 2A类，而 GP 不属于 2A类", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-f1080e8ddf6a7b26f417419f", "question": "根据 CSCO 2025 儿童章节，在非转移性儿童鼻咽癌中，被列为 3类推荐的诱导方案是：", "options": {"A": "GP", "B": "PF", "C": "TPF", "D": "TP"}, "answer": "A", "choices": ["A. GP", "B. PF", "C. TPF", "D. TP"], "explanation": "儿童非转移性 NPC 的诱导化疗分层中，GP 被列为 3类推荐；PF、TPF、TP 均高于这一层级。这里故意用“成人常见高权重方案”作干扰，以避免机械套用成人路径。", "source": "CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表18", "evidence_anchors": ["CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表18"], "answer_text": "GP", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-0a6451951bee0afcf3faf037", "question": "根据 CSCO 2025 儿童章节，对儿童鼻咽癌，下列哪项表述更准确？", "options": {"A": "治疗策略通常参照成人框架，但需更强调长期毒性与生长发育影响", "B": "同期化疗的唯一最佳方案已由高质量随机研究完全确立", "C": "IFN-β 已成为所有患儿绝对标准治疗", "D": "儿童放疗剂量原则上应尽可能高于成人"}, "answer": "A", "choices": ["A. 治疗策略通常参照成人框架，但需更强调长期毒性与生长发育影响", "B. 同期化疗的唯一最佳方案已由高质量随机研究完全确立", "C. IFN-β 已成为所有患儿绝对标准治疗", "D. 儿童放疗剂量原则上应尽可能高于成人"], "explanation": "儿童 NPC 的现实策略是“借鉴成人框架，但更重视长期毒性”。目前并不存在所有患儿统一适用、且已由高质量随机证据完全定型的单一最佳同步方案；IFN-β 也不是所有患儿都必须接受的绝对标准。", "source": "CSCO 2025 第10.3节非转移儿童鼻咽癌治疗；表17–20及相关注释", "evidence_anchors": ["CSCO 2025 第10.3节非转移儿童鼻咽癌治疗", "表17–20及相关注释"], "answer_text": "治疗策略通常参照成人框架，但需更强调长期毒性与生长发育影响", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-a1f5d250a269eed3524c947b", "question": "根据 CSCO 2025 表17，非转移儿童鼻咽癌分层中，ⅣB期的表格推荐最符合的是：", "options": {"A": "全身化疗 ± 局部放疗（3类）", "B": "单纯放疗（3类）", "C": "诱导化疗 + 同期放化疗（2A类）", "D": "免疫联合放疗（1A类）"}, "answer": "A", "choices": ["A. 全身化疗 ± 局部放疗（3类）", "B. 单纯放疗（3类）", "C. 诱导化疗 + 同期放化疗（2A类）", "D. 免疫联合放疗（1A类）"], "explanation": "儿童章节表17中，ⅣB期写法为全身化疗±局部放疗（3类）。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "全身化疗 ± 局部放疗（3类）", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-9ed3fd7d9013449db044e755", "question": "根据 CSCO 2025 表18，儿童鼻咽癌诱导化疗推荐中，GP 方案的推荐等级是：", "options": {"A": "1A类", "B": "1B类", "C": "2A类", "D": "3类"}, "answer": "D", "choices": ["A. 1A类", "B. 1B类", "C. 2A类", "D. 3类"], "explanation": "儿童章节表18中，GP（吉西他滨+顺铂）在诱导化疗里列为 3类，而 PF/TPF/TP 多为 2A类。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "3类", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-2cd317398631c63e91a79883", "question": "根据 CSCO 2025 表19，儿童鼻咽癌 TPF 方案的典型周期写法最符合的是：", "options": {"A": "每3周一次，共3–4疗程", "B": "每4周一次，共2疗程", "C": "每2周一次，共6疗程", "D": "每周一次，共7疗程"}, "answer": "A", "choices": ["A. 每3周一次，共3–4疗程", "B. 每4周一次，共2疗程", "C. 每2周一次，共6疗程", "D. 每周一次，共7疗程"], "explanation": "儿童章节表19中，TPF 方案被写为 3周一次，共3–4个疗程。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "每3周一次，共3–4疗程", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-10a122429460a58c463c61ca", "question": "根据 CSCO 2025 表19，儿童鼻咽癌 GP 诱导方案中，吉西他滨与顺铂的给药时间最符合的是：", "options": {"A": "吉西他滨 d1；顺铂 d8", "B": "二者均 d1–4", "C": "二者均每周一次连续7周", "D": "吉西他滨 d1、8；顺铂 d1"}, "answer": "D", "choices": ["A. 吉西他滨 d1；顺铂 d8", "B. 二者均 d1–4", "C. 二者均每周一次连续7周", "D. 吉西他滨 d1、8；顺铂 d1"], "explanation": "表19写明儿童 GP 方案为：吉西他滨 1000 mg/m² d1、8；顺铂 80 mg/m² d1。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "吉西他滨 d1、8；顺铂 d1", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-01aea8e975211e325cf7d0d6", "question": "根据 CSCO 2025 儿童注释，关于儿童鼻咽癌诱导化疗方案中的甲氨蝶呤和博来霉素，最符合表述的是：", "options": {"A": "由于不良反应较大，已罕有应用", "B": "仅用于 T1N0 患儿", "C": "只能与免疫治疗联合使用", "D": "由于疗效最好，应成为儿童标准首选"}, "answer": "A", "choices": ["A. 由于不良反应较大，已罕有应用", "B. 仅用于 T1N0 患儿", "C. 只能与免疫治疗联合使用", "D. 由于疗效最好，应成为儿童标准首选"], "explanation": "CSCO 2025 儿童章节注释明确指出，MPF、PMB、BEP 等方案中的甲氨蝶呤和博来霉素因不良反应较大，已罕有应用。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "由于不良反应较大，已罕有应用", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-A. 儿童初治分层与诱导治疗"} |
| {"id": "l1-sample-2a68cd5200ff90b14fa63608", "question": "根据 CSCO 2025 儿童章节，关于复发/转移儿童鼻咽癌，下列哪项最准确？", "options": {"A": "证据较少，可参考成人已证实有效的治疗原则", "B": "原则上完全不考虑局部治疗", "C": "免疫治疗已成所有患儿标准一线", "D": "证据非常充分，已有大量随机III期标准"}, "answer": "A", "choices": ["A. 证据较少，可参考成人已证实有效的治疗原则", "B. 原则上完全不考虑局部治疗", "C. 免疫治疗已成所有患儿标准一线", "D. 证据非常充分，已有大量随机III期标准"], "explanation": "CSCO儿童复发/转移部分指出证据有限，可参考成人已证实有效的原则。", "source": "CSCO 2025 §10.4 复发/转移儿童鼻咽癌的治疗", "evidence_anchors": ["CSCO 2025 §10.4 复发/转移儿童鼻咽癌的治疗"], "answer_text": "证据较少，可参考成人已证实有效的治疗原则", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-B. 儿童复发/转移与高危场景"} |
| {"id": "l1-sample-fac80c5d96c28126fbe269cc", "question": "根据 CSCO 2025 儿童章节，对初治即存在转移的儿童鼻咽癌，在转移灶控制前提下可考虑：", "options": {"A": "只做手术", "B": "永远不照射原发灶", "C": "只做观察", "D": "照射原发灶"}, "answer": "D", "choices": ["A. 只做手术", "B. 永远不照射原发灶", "C. 只做观察", "D. 照射原发灶"], "explanation": "CSCO指出初治转移患儿在转移灶获得控制前提下可照射原发灶。", "source": "CSCO 2025 §10.4 复发/转移儿童鼻咽癌的治疗", "evidence_anchors": ["CSCO 2025 §10.4 复发/转移儿童鼻咽癌的治疗"], "answer_text": "照射原发灶", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-B. 儿童复发/转移与高危场景"} |
| {"id": "l1-sample-6ea0e7e7f7d1232b5ec3cd46", "question": "根据 CSCO 2025 儿童章节，对寡转移儿童鼻咽癌，更强调：", "options": {"A": "化疗基础上的局部治疗", "B": "只做放疗不做药物", "C": "只做免疫单药", "D": "单纯支持治疗"}, "answer": "A", "choices": ["A. 化疗基础上的局部治疗", "B. 只做放疗不做药物", "C. 只做免疫单药", "D. 单纯支持治疗"], "explanation": "CSCO儿童复发/转移原则强调寡转移患儿应重视化疗基础上的局部治疗整合。", "source": "CSCO 2025 §10.4 复发/转移儿童鼻咽癌的治疗", "evidence_anchors": ["CSCO 2025 §10.4 复发/转移儿童鼻咽癌的治疗"], "answer_text": "化疗基础上的局部治疗", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-B. 儿童复发/转移与高危场景"} |
| {"id": "l1-sample-6c4a0a7c84e45844861dbd6a", "question": "根据 CSCO 2025 儿童章节，儿童鼻咽癌同期化疗推荐的核心药物是？", "options": {"A": "卡铂", "B": "顺铂", "C": "PD-1抑制剂", "D": "5-FU"}, "answer": "B", "choices": ["A. 卡铂", "B. 顺铂", "C. PD-1抑制剂", "D. 5-FU"], "explanation": "儿童鼻咽癌同期化疗推荐的核心药物仍是顺铂，而不是直接照搬成人复发/转移NPC的免疫药或把5-FU/卡铂作为首选。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表19–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表19–20"], "answer_text": "顺铂", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-2182621ca9ae06ec97af5afb", "question": "根据 CSCO 2025 儿童章节，儿童鼻咽癌同步“周疗”顺铂的常用剂量为：", "options": {"A": "20 mg/m²，每周 1 次", "B": "100 mg/m²，d1，每 3 周 1 次", "C": "30–40 mg/m²，每周 1 次", "D": "80 mg/m²，d1，每 3 周 1 次"}, "answer": "C", "choices": ["A. 20 mg/m²，每周 1 次", "B. 100 mg/m²，d1，每 3 周 1 次", "C. 30–40 mg/m²，每周 1 次", "D. 80 mg/m²，d1，每 3 周 1 次"], "explanation": "儿童 NPC 同步周疗顺铂的常用剂量为 30–40 mg/m²，每周 1 次。80 mg/m² 与 100 mg/m² 属于三周方案或 RM-NPC 方案中的典型干扰剂量，不应混入儿童周疗同步治疗。", "source": "CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表19", "evidence_anchors": ["CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表19"], "answer_text": "30–40 mg/m²，每周 1 次", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-d018761555b7d9792531907c", "question": "根据 CSCO 2025 儿童章节，儿童鼻咽癌同步“三周方案”顺铂的常用剂量为：", "options": {"A": "30–40 mg/m²，每周 1 次", "B": "80 mg/m²，d1，每 3 周 1 次", "C": "100 mg/m²，d1，每 3 周 1 次", "D": "120 mg/m²，d1，每 3 周 1 次"}, "answer": "C", "choices": ["A. 30–40 mg/m²，每周 1 次", "B. 80 mg/m²，d1，每 3 周 1 次", "C. 100 mg/m²，d1，每 3 周 1 次", "D. 120 mg/m²，d1，每 3 周 1 次"], "explanation": "儿童 NPC 同步三周顺铂的常用剂量为 100 mg/m²，d1，每 3 周 1 次。80 mg/m² 容易与 RM-NPC 的 GP 方案顺铂剂量混淆，但不是这里的标准答案。", "source": "CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表19", "evidence_anchors": ["CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表19"], "answer_text": "100 mg/m²，d1，每 3 周 1 次", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-50eb35b884522b916f3f68f0", "question": "根据 CSCO 2025 儿童章节，儿童鼻咽癌辅助 IFN-β 的常用方案为：", "options": {"A": "250 mg 口服每日，持续半年", "B": "3 mg/kg q2w，共 6 个月", "C": "100000 IU/kg，每周 3 次，共 6 个月", "D": "200 mg q3w，共 1 年"}, "answer": "C", "choices": ["A. 250 mg 口服每日，持续半年", "B. 3 mg/kg q2w，共 6 个月", "C. 100000 IU/kg，每周 3 次，共 6 个月", "D. 200 mg q3w，共 1 年"], "explanation": "儿童 NPC 中的 IFN-β 属于非常具体的儿科条目，常用方案为 100000 IU/kg、每周 3 次、共 6 个月。其余选项分别借用了口服靶向药、成人免疫药或完全不匹配的给药格式。", "source": "CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表19", "evidence_anchors": ["CSCO 2025 第10.3节非转移儿童鼻咽癌治疗 + 表19"], "answer_text": "100000 IU/kg，每周 3 次，共 6 个月", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-a2ae8e3120f3ad95c25d04e4", "question": "根据 CSCO 2025 儿童章节，关于儿童鼻咽癌放疗，最符合指南表述的是？", "options": {"A": "不需考虑改野、缩野", "B": "总剂量不能低于70 Gy", "C": "一律70–72 Gy", "D": "每天分割剂量可降至 1.8 Gy，以减少后遗症"}, "answer": "D", "choices": ["A. 不需考虑改野、缩野", "B. 总剂量不能低于70 Gy", "C. 一律70–72 Gy", "D. 每天分割剂量可降至 1.8 Gy，以减少后遗症"], "explanation": "儿童NPC放疗并非所有人一律70 Gy。对诱导反应好者，可按CR/PR/SD分层减量，目标是兼顾肿瘤控制与生长发育、内分泌和神经系统长期安全。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表20"], "answer_text": "每天分割剂量可降至 1.8 Gy，以减少后遗症", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-b73d036443c30e13aeb022a6", "question": "儿童非转移鼻咽癌，诱导治疗后达到CR。按CSCO儿童章节，更合理的放疗剂量是？", "options": {"A": "60–61.2 Gy", "B": "66–68 Gy", "C": "固定70 Gy", "D": "54 Gy"}, "answer": "A", "choices": ["A. 60–61.2 Gy", "B. 66–68 Gy", "C. 固定70 Gy", "D. 54 Gy"], "explanation": "儿童NPC对诱导反应好的患者可探索减量放疗。CSCO儿童表格给出CR时PTVp/PTVn约60–61.2 Gy，而不是一律70 Gy。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "60–61.2 Gy", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-66ded656173ccc46c52640cd", "question": "关于儿童鼻咽癌的IFN-β辅助治疗，以下最符合指南精神的是？", "options": {"A": "已被证实可替代同期顺铂", "B": "所有患儿的绝对标准治疗", "C": "对局部晚期或诱导反应不良患儿可作为治疗选择，但暂无统一专家共识", "D": "仅用于复发/转移患儿"}, "answer": "C", "choices": ["A. 已被证实可替代同期顺铂", "B. 所有患儿的绝对标准治疗", "C. 对局部晚期或诱导反应不良患儿可作为治疗选择，但暂无统一专家共识", "D. 仅用于复发/转移患儿"], "explanation": "CSCO儿童章节明确指出，IFN-β可作为局部晚期或诱导反应不良患儿的一种治疗选择，但尚无统一专家共识，不能写成‘所有患儿的标准必选项’。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "对局部晚期或诱导反应不良患儿可作为治疗选择，但暂无统一专家共识", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-9cf319877af91ad59db51fcd", "question": "根据 CSCO 2025，关于儿童鼻咽癌同期化疗的最佳策略，更准确的表述是：", "options": {"A": "随机对照证据充分，结论已完全统一", "B": "儿童同期化疗仅能用卡铂", "C": "儿童一律不应做同期化疗", "D": "关于最佳策略仍存在争议"}, "answer": "D", "choices": ["A. 随机对照证据充分，结论已完全统一", "B. 儿童同期化疗仅能用卡铂", "C. 儿童一律不应做同期化疗", "D. 关于最佳策略仍存在争议"], "explanation": "CSCO 2025 明确指出儿童鼻咽癌同期化疗最佳策略仍存在争议。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "关于最佳策略仍存在争议", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-1470f6d5b4462567b3c73c88", "question": "根据 CSCO 2025，对诱导化疗后达到 CR 或非常好部分缓解（VGPR）的儿童鼻咽癌患者，部分学者提出可考虑：", "options": {"A": "单纯放疗/降级放疗策略", "B": "完全省略放疗", "C": "直接转入免疫维持", "D": "必须三药同步化疗"}, "answer": "A", "choices": ["A. 单纯放疗/降级放疗策略", "B. 完全省略放疗", "C. 直接转入免疫维持", "D. 必须三药同步化疗"], "explanation": "2025版儿童章节指出，部分学者认为对诱导后 CR 或 VGPR 的患儿可考虑单纯放疗或降级放疗。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "单纯放疗/降级放疗策略", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-44b7f7cb27142236d0707baa", "question": "根据 CSCO 2025 表19，儿童鼻咽癌同期化疗的 DDP 单周方案与三周方案，最符合表格的是：", "options": {"A": "单周 30–40 mg/m²，共3疗程；三周 100 mg/m²，共7疗程", "B": "单周与三周方案剂量完全相同", "C": "单周 30–40 mg/m²，共7疗程；三周 100 mg/m²，共3疗程", "D": "单周 20 mg/m²，共4疗程；三周 80 mg/m²，共6疗程"}, "answer": "C", "choices": ["A. 单周 30–40 mg/m²，共3疗程；三周 100 mg/m²，共7疗程", "B. 单周与三周方案剂量完全相同", "C. 单周 30–40 mg/m²，共7疗程；三周 100 mg/m²，共3疗程", "D. 单周 20 mg/m²，共4疗程；三周 80 mg/m²，共6疗程"], "explanation": "表19中，儿童同期化疗的 DDP 单周方案为 30–40 mg/m² 每周1次，共7个疗程；三周方案为 100 mg/m²，3周一次，共3个疗程。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "单周 30–40 mg/m²，共7疗程；三周 100 mg/m²，共3疗程", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-60e4145b3c2b5f14f9c75535", "question": "根据 CSCO 2025 表20，儿童鼻咽癌诱导化疗后达到 CR 时，PTVp/PTVn 的推荐放疗剂量是：", "options": {"A": "68–70 Gy", "B": "60–61.2 Gy", "C": "54 Gy", "D": "60–66 Gy"}, "answer": "B", "choices": ["A. 68–70 Gy", "B. 60–61.2 Gy", "C. 54 Gy", "D. 60–66 Gy"], "explanation": "儿童放疗剂量表中，诱导后 CR 时 PTVp/PTVn 推荐 60–61.2 Gy；PR 为 60–66 Gy；SD 为 68–70 Gy。", "source": "CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗；CSCO 2025 表17–20", "evidence_anchors": ["CSCO 2025 §10.3 非转移儿童鼻咽癌的治疗", "CSCO 2025 表17–20"], "answer_text": "60–61.2 Gy", "domain": "儿童鼻咽癌", "source_type": "CSCO-only", "scope_major": "VII. 儿童与青少年NPC", "scope_minor": "VII-C. 儿童放疗、同期化疗与辅助治疗"} |
| {"id": "l1-sample-16f2a3d0f1e061283e7a4cde", "question": "根据 CSCO 2025，放化疗结束后的首次系统随访评估通常建议在？", "options": {"A": "4 周", "B": "12–16 周", "C": "1–2 周", "D": "1 年"}, "answer": "B", "choices": ["A. 4 周", "B. 12–16 周", "C. 1–2 周", "D. 1 年"], "explanation": "CSCO随访表建议放化疗结束后约12–16周进行首次系统随访评估，而不是治疗结束后一两周就做完整疗效判断。", "source": "CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "12–16 周", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-eb1364b4a3adcedd94dad55e", "question": "根据 CSCO 2025，对 IMRT 结束时 MRI 仍可检出残留病灶者，可考虑？", "options": {"A": "一律进入后线免疫", "B": "一律停治观察", "C": "一律直接手术", "D": "追加 2–3 次、每次 4–6 Gy 的 boost"}, "answer": "D", "choices": ["A. 一律进入后线免疫", "B. 一律停治观察", "C. 一律直接手术", "D. 追加 2–3 次、每次 4–6 Gy 的 boost"], "explanation": "对IMRT结束时MRI仍可检出残留病灶者，CSCO允许考虑追加2–3次、每次4–6 Gy的boost。它不是一律立即手术或直接进入后线治疗。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "追加 2–3 次、每次 4–6 Gy 的 boost", "domain": "诊断、病理与初始评估", "source_type": "CSCO-only", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-edbecdb3d31b0fdd56830a9e", "question": "根据 NCCN 2025，治疗后 FDG-PET/CT 作为 preferred response assessment 的时点通常应？", "options": {"A": "8–12周，与CT/MRI反应评估完全等同", "B": "≥12周", "C": "仅在出现症状后再做", "D": "<4周，以尽早识别治疗失败"}, "answer": "B", "choices": ["A. 8–12周，与CT/MRI反应评估完全等同", "B. ≥12周", "C. 仅在出现症状后再做", "D. <4周，以尽早识别治疗失败"], "explanation": "NCCN把治疗后FDG-PET/CT作为preferred response assessment时点通常放在≥12周。过早做PET/CT容易受炎性反应干扰；8–12周更常见于CT/MRI的反应评估窗口。", "source": "NCCN 2025 FOLL-A；NCCN 2025 IMG-A（治疗后影像/FDG-PET 反应评估时点）", "evidence_anchors": ["NCCN 2025 FOLL-A", "NCCN 2025 IMG-A（治疗后影像/FDG-PET 反应评估时点）"], "answer_text": "≥12周", "domain": "诊断、病理与初始评估", "source_type": "NCCN-only", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-1a1a7bf160a7b195c042f7d8", "question": "放化疗结束后6周行FDG-PET/CT显示鼻咽原发区代谢轻中度升高。按NCCN，最准确的判断是？", "options": {"A": "这个时点已经是preferred response assessment", "B": "时点过早，PET/CT首选评估通常应≥12周", "C": "可直接判定进展并进入二线", "D": "可直接判定残留并手术"}, "answer": "B", "choices": ["A. 这个时点已经是preferred response assessment", "B. 时点过早，PET/CT首选评估通常应≥12周", "C. 可直接判定进展并进入二线", "D. 可直接判定残留并手术"], "explanation": "NCCN把治疗后FDG-PET/CT的preferred response assessment时点放在≥12周。6周时炎症反应尚明显，过早判定残留/进展会增加假阳性。", "source": "NCCN 2025 FOLL-A；NCCN 2025 IMG-A；CSCO 2025 §13", "evidence_anchors": ["NCCN 2025 FOLL-A", "NCCN 2025 IMG-A", "CSCO 2025 §13"], "answer_text": "时点过早，PET/CT首选评估通常应≥12周", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-04e68083241a942b25a5de52", "question": "治疗后≥12周PET/CT结果equivocal，无明确进行性症状。按NCCN，最符合指南的是？", "options": {"A": "观察或3–6个月后重复PET/CT", "B": "立即按复发处理", "C": "立即永久停止随访", "D": "直接行系统治疗"}, "answer": "A", "choices": ["A. 观察或3–6个月后重复PET/CT", "B. 立即按复发处理", "C. 立即永久停止随访", "D. 直接行系统治疗"], "explanation": "NCCN对equivocal PET/CT并不要求立刻启动挽救治疗，而是允许观察或3–6个月后复查PET/CT。只有strongly positive或进一步证实才推进局部挽救/系统治疗。", "source": "NCCN 2025 FOLL-A；NCCN 2025 IMG-A；CSCO 2025 §13", "evidence_anchors": ["NCCN 2025 FOLL-A", "NCCN 2025 IMG-A", "CSCO 2025 §13"], "answer_text": "观察或3–6个月后重复PET/CT", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-b1082e23b99d6f246a03d5f9", "question": "IMRT结束时MRI仍见明确残留病灶，且病灶位置允许继续补量。按CSCO，更符合指南的是？", "options": {"A": "一律停治观察", "B": "必须直接手术", "C": "追加2–3次、每次4–6 Gy boost", "D": "必须立即转免疫治疗"}, "answer": "C", "choices": ["A. 一律停治观察", "B. 必须直接手术", "C. 追加2–3次、每次4–6 Gy boost", "D. 必须立即转免疫治疗"], "explanation": "CSCO允许对IMRT结束时MRI仍有残留的病例追加2–3次、每次4–6 Gy的boost。这个处理是局部控制强化，而不是一律改走挽救路径。", "source": "CSCO 2025 §3.2 放疗流程与质控；CSCO 2025 表7", "evidence_anchors": ["CSCO 2025 §3.2 放疗流程与质控", "CSCO 2025 表7"], "answer_text": "追加2–3次、每次4–6 Gy boost", "domain": "诊断、病理与初始评估", "source_type": "CSCO-only", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-066350438d0dc92cd4d5d4f8", "question": "根据 CSCO 2025，关于 PET/CT 与 MRI 在复发/残留评估中的定位，最准确的是：", "options": {"A": "二者都不推荐用于复发评估", "B": "对原发灶复发/残留诊断困难者，推荐 PET/CT 与 MRI 联合应用", "C": "MRI 可完全替代 PET/CT", "D": "PET/CT 可完全替代 MRI"}, "answer": "B", "choices": ["A. 二者都不推荐用于复发评估", "B. 对原发灶复发/残留诊断困难者，推荐 PET/CT 与 MRI 联合应用", "C. MRI 可完全替代 PET/CT", "D. PET/CT 可完全替代 MRI"], "explanation": "CSCO 2025 明确指出对鼻咽原发灶复发/残留诊断困难的病例，推荐联合应用 PET/CT 与 MRI。", "source": "NCCN 2025 FOLL-A；NCCN 2025 IMG-A；CSCO 2025 §13", "evidence_anchors": ["NCCN 2025 FOLL-A", "NCCN 2025 IMG-A", "CSCO 2025 §13"], "answer_text": "对原发灶复发/残留诊断困难者，推荐 PET/CT 与 MRI 联合应用", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-bb192a7272cc8191636a3a40", "question": "根据 CSCO 2025 表22，关于随访中 PET/CT 的触发条件，最符合表格的是：", "options": {"A": "主要用于临床怀疑远处转移，或 EBV DNA 升高的 T4/N3 患者", "B": "所有患者每次复查都常规做 PET/CT", "C": "5年后才允许做 PET/CT", "D": "仅限 T1N0 患者"}, "answer": "A", "choices": ["A. 主要用于临床怀疑远处转移，或 EBV DNA 升高的 T4/N3 患者", "B. 所有患者每次复查都常规做 PET/CT", "C. 5年后才允许做 PET/CT", "D. 仅限 T1N0 患者"], "explanation": "表22中 PET/CT 被列为Ⅱ级推荐，主要用于临床怀疑远处转移患者，或 EBV DNA 拷贝数升高的 T4/N3 患者。", "source": "CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "主要用于临床怀疑远处转移，或 EBV DNA 升高的 T4/N3 患者", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-A. 疗效评估与复查时点"} |
| {"id": "l1-sample-865c0bde9671374c9000b846", "question": "根据 CSCO 2025，鼻咽癌最常用、应用最广泛的营养风险筛查工具是：", "options": {"A": "Child-Pugh", "B": "CHA2DS2-VASc", "C": "NRS 2002", "D": "APACHE II"}, "answer": "C", "choices": ["A. Child-Pugh", "B. CHA2DS2-VASc", "C. NRS 2002", "D. APACHE II"], "explanation": "CSCO营养管理部分指出，恶性肿瘤中应用最广泛的营养风险筛查工具为NRS 2002。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "NRS 2002", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-B. 营养与支持治疗"} |
| {"id": "l1-sample-a3e915677acfe060e3265afd", "question": "根据 CSCO 2025，放疗期间出现高营养风险，通常指 NRS 2002 评分：", "options": {"A": ">3", "B": "=1", "C": "<3", "D": "≥2"}, "answer": "A", "choices": ["A. >3", "B. =1", "C. <3", "D. ≥2"], "explanation": "CSCO指出NRS 2002评分>3提示高营养风险。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": ">3", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-B. 营养与支持治疗"} |
| {"id": "l1-sample-5a06671fc606d2ad1c9b819c", "question": "根据 CSCO 2025，关于营养支持时机，下列最符合证据导向的是：", "options": {"A": "等体重下降>10%再干预", "B": "鼻咽癌不需要系统营养筛查", "C": "放疗开始时尽早营养干预优于晚期被动干预", "D": "白蛋白正常就无需营养评估"}, "answer": "C", "choices": ["A. 等体重下降>10%再干预", "B. 鼻咽癌不需要系统营养筛查", "C. 放疗开始时尽早营养干预优于晚期被动干预", "D. 白蛋白正常就无需营养评估"], "explanation": "CSCO引用研究显示，放疗开始时尽早干预可减少黏膜炎和营养恶化。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "放疗开始时尽早营养干预优于晚期被动干预", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-B. 营养与支持治疗"} |
| {"id": "l1-sample-52fa27913a9c19667d2bc6a0", "question": "根据 CSCO 2025，关于营养不良对鼻咽癌放疗的影响，下列哪项最符合指南表述？", "options": {"A": "只影响化疗，不影响放疗", "B": "仅影响体重，不影响治疗过程", "C": "可导致放疗中断、摆位误差增大和放疗敏感性降低", "D": "反而可提高局部控制率"}, "answer": "C", "choices": ["A. 只影响化疗，不影响放疗", "B. 仅影响体重，不影响治疗过程", "C. 可导致放疗中断、摆位误差增大和放疗敏感性降低", "D. 反而可提高局部控制率"], "explanation": "CSCO 营养管理部分明确指出：营养不良会造成放疗中断、摆位误差增大、放疗敏感性降低，并影响预后。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "可导致放疗中断、摆位误差增大和放疗敏感性降低", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-B. 营养与支持治疗"} |
| {"id": "l1-sample-2e015c2250a8dc755f997fdd", "question": "根据 CSCO 2025，下列哪项最符合鼻咽癌围放疗期营养管理原则？", "options": {"A": "只有体重下降 >10% 后才需要开始营养干预", "B": "放疗完成后再开始营养评估最合理", "C": "仅高龄患者需要营养管理", "D": "所有鼻咽癌放疗患者都需要全程规范化营养管理"}, "answer": "D", "choices": ["A. 只有体重下降 >10% 后才需要开始营养干预", "B. 放疗完成后再开始营养评估最合理", "C. 仅高龄患者需要营养管理", "D. 所有鼻咽癌放疗患者都需要全程规范化营养管理"], "explanation": "CSCO 2025 对鼻咽癌围放疗期营养管理的立场非常明确：不是“等出现明显消耗再补救”，而是所有放疗患者均应接受全程规范化营养管理与动态评估。题目考的是“普遍性原则”，不是某个营养阈值。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "所有鼻咽癌放疗患者都需要全程规范化营养管理", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-B. 营养与支持治疗"} |
| {"id": "l1-sample-4c3b430d844e15202d1e3cb7", "question": "根据 CSCO 2025 与 NCCN 2025，对鼻咽癌长期生存者的规范管理，更合理的是？", "options": {"A": "只要影像学无复发，就无需系统性长期管理", "B": "主要围绕EBV DNA和鼻咽镜，其他管理可弱化", "C": "同时关注复发监测、吞咽/营养、听力、内分泌及晚期放疗毒性", "D": "以复发监测为唯一目标，其余问题按需处理"}, "answer": "C", "choices": ["A. 只要影像学无复发，就无需系统性长期管理", "B. 主要围绕EBV DNA和鼻咽镜，其他管理可弱化", "C. 同时关注复发监测、吞咽/营养、听力、内分泌及晚期放疗毒性", "D. 以复发监测为唯一目标，其余问题按需处理"], "explanation": "鼻咽癌长期管理不能只盯复发；更合理的是同时关注吞咽/营养、听力、内分泌、晚期放疗毒性及其他生存质量问题。这与NCCN survivorship和CSCO随访思路一致。", "source": "CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "同时关注复发监测、吞咽/营养、听力、内分泌及晚期放疗毒性", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-43db1d63689c39536601a042", "question": "根据 CSCO 2025，下列哪项更属于鼻咽癌放疗晚期不良反应？", "options": {"A": "口腔急性黏膜炎", "B": "急性放射性皮炎", "C": "短暂恶心", "D": "张口困难"}, "answer": "D", "choices": ["A. 口腔急性黏膜炎", "B. 急性放射性皮炎", "C. 短暂恶心", "D. 张口困难"], "explanation": "张口困难是NPC放疗较典型的晚期毒性之一。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "张口困难", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-a6087cb3f27104a7d6f41b23", "question": "根据 NCCN 2025，鼻咽癌长期支持性评估中，应按临床需要考虑：", "options": {"A": "仅复查甲状腺彩超", "B": "营养、吞咽/言语、听力、眼科/内分泌", "C": "仅复查鼻咽镜", "D": "仅复查血常规"}, "answer": "B", "choices": ["A. 仅复查甲状腺彩超", "B. 营养、吞咽/言语、听力、眼科/内分泌", "C. 仅复查鼻咽镜", "D. 仅复查血常规"], "explanation": "NCCN workup和随访原则都强调营养、吞咽、听力和内分泌等长期管理。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "营养、吞咽/言语、听力、眼科/内分泌", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-1d427f6c293c6c0ffd712a05", "question": "根据 NCCN 2025，除肿瘤复查外，长期survivorship管理中还应持续关注：", "options": {"A": "仅甲状腺功能", "B": "抑郁、吞咽/言语、听力、营养与淋巴水肿", "C": "仅血浆EBV DNA", "D": "仅影像学变化"}, "answer": "B", "choices": ["A. 仅甲状腺功能", "B. 抑郁、吞咽/言语、听力、营养与淋巴水肿", "C. 仅血浆EBV DNA", "D. 仅影像学变化"], "explanation": "NCCN survivorship明确提出功能、营养、心理和治疗相关长期毒性都应纳入持续管理。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "抑郁、吞咽/言语、听力、营养与淋巴水肿", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-969c211f3b2f9f407f40ca8e", "question": "根据 NCCN 2025，对颅底接受高剂量放疗的长期生存者，可考虑的长期内分泌评估是：", "options": {"A": "无需任何内分泌随访", "B": "定期骨髓活检", "C": "定期垂体功能评估", "D": "仅AFP检测"}, "answer": "C", "choices": ["A. 无需任何内分泌随访", "B. 定期骨髓活检", "C. 定期垂体功能评估", "D. 仅AFP检测"], "explanation": "NCCN提到颅底放疗后长期存活者可考虑垂体/内分泌评估。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "定期垂体功能评估", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-b7204ebf3b7e9c3310d6e889", "question": "根据 CSCO 2025，下列哪项更属于鼻咽癌放疗严重晚期并发症，并且在局部复发/坏死分层中具有重要意义？", "options": {"A": "一过性轻度恶心", "B": "鼻咽坏死", "C": "短暂味觉减退", "D": "口腔黏膜急性充血"}, "answer": "B", "choices": ["A. 一过性轻度恶心", "B. 鼻咽坏死", "C. 短暂味觉减退", "D. 口腔黏膜急性充血"], "explanation": "CSCO 在复发/手术章节特别强调鼻咽坏死不仅是严重放疗并发症，还可据放疗疗程数和颈内动脉暴露情况进行临床风险分层。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "鼻咽坏死", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-467bc390cdf6ae6c19b899e1", "question": "根据 NCCN 2025，除 TSH 外，对长期存活的鼻咽癌患者，下列哪项也属于随访中应持续关注的 supportive care 重点？", "options": {"A": "抑郁、淋巴水肿、吞咽/言语、听力、营养与功能康复", "B": "仅肿瘤标志物CEA", "C": "仅胸片", "D": "仅血脂"}, "answer": "A", "choices": ["A. 抑郁、淋巴水肿、吞咽/言语、听力、营养与功能康复", "B. 仅肿瘤标志物CEA", "C. 仅胸片", "D. 仅血脂"], "explanation": "NCCN survivorship/follow-up 明确把 depression、lymphedema、speech/swallowing、hearing、nutrition、function 等列入长期管理重点。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "抑郁、淋巴水肿、吞咽/言语、听力、营养与功能康复", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-614b023765fc8a6ca7adb51f", "question": "根据 CSCO 2025 表22及注释，关于鼻咽癌随访表中的长期功能评估，下列哪项最符合指南原文？", "options": {"A": "4–5年及5年以上随访仍建议关注口腔、听力、视力、吞咽、营养和功能康复评估", "B": "功能康复只在儿童患者中需要", "C": "随访表只强调影像，不涉及功能问题", "D": "5年后仅保留鼻咽镜，不再做功能评估"}, "answer": "A", "choices": ["A. 4–5年及5年以上随访仍建议关注口腔、听力、视力、吞咽、营养和功能康复评估", "B. 功能康复只在儿童患者中需要", "C. 随访表只强调影像，不涉及功能问题", "D. 5年后仅保留鼻咽镜，不再做功能评估"], "explanation": "CSCO 2025 表22和注释明确写到：4–5年及5年以上随访仍应纳入口腔、听力、视力、吞咽、营养和功能/康复评估。", "source": "CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "4–5年及5年以上随访仍建议关注口腔、听力、视力、吞咽、营养和功能康复评估", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-C. Survivorship与晚期毒性"} |
| {"id": "l1-sample-4fdf6f392d97872ec8afe2a0", "question": "根据 CSCO 2025，第 1–3 年的常规随访频率通常为？", "options": {"A": "每 6–12 个月一次", "B": "每年一次", "C": "每 3–6 个月一次", "D": "每月一次"}, "answer": "C", "choices": ["A. 每 6–12 个月一次", "B. 每年一次", "C. 每 3–6 个月一次", "D. 每月一次"], "explanation": "CSCO通常建议第1–3年每3–6个月随访一次。这个节奏与NCCN第1年1–3个月一次并不相同，所以题目必须锁来源。", "source": "CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "每 3–6 个月一次", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-D. 随访策略与高危人群管理"} |
| {"id": "l1-sample-b48f2f10292139e9c3c77901", "question": "根据 CSCO 2025，第 4–5 年的常规随访频率通常为？", "options": {"A": "每 6–12 个月", "B": "每 3–6 个月", "C": "每 1–3 个月", "D": "每 2 年一次"}, "answer": "A", "choices": ["A. 每 6–12 个月", "B. 每 3–6 个月", "C. 每 1–3 个月", "D. 每 2 年一次"], "explanation": "CSCO通常建议第4–5年每6–12个月随访一次。超过5年后可逐步延长，但仍强调长期/终身随访意识。", "source": "CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "每 6–12 个月", "domain": "放疗技术、流程与OAR", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-D. 随访策略与高危人群管理"} |
| {"id": "l1-sample-3be85edecfd9210fecdec70b", "question": "根据 CSCO 2025，关于鼻咽癌随访策略，下列最准确的是：", "options": {"A": "5年后不再需要随访", "B": "所有患者统一随访频率，无需风险分层", "C": "应采用分层管理并强调终身随访", "D": "仅复发后才随访"}, "answer": "C", "choices": ["A. 5年后不再需要随访", "B. 所有患者统一随访频率，无需风险分层", "C. 应采用分层管理并强调终身随访", "D. 仅复发后才随访"], "explanation": "CSCO影像与随访注释明确提出分层管理并强调终身随访。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "应采用分层管理并强调终身随访", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-D. 随访策略与高危人群管理"} |
| {"id": "l1-sample-2dd93fc6498c7cc8e8c299d1", "question": "根据 CSCO 2025，哪类患者在治疗后5年内更需要密切随访？", "options": {"A": "仅角化型患者", "B": "仅T1N0", "C": "仅儿童患者", "D": "局部晚期（T3–4或N2–3）患者"}, "answer": "D", "choices": ["A. 仅角化型患者", "B. 仅T1N0", "C. 仅儿童患者", "D. 局部晚期（T3–4或N2–3）患者"], "explanation": "CSCO指出局部晚期（T3–4或N2–3）患者更易在5年内复发/转移。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "局部晚期（T3–4或N2–3）患者", "domain": "随访、支持治疗与长期管理", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-D. 随访策略与高危人群管理"} |
| {"id": "l1-sample-ef14abbfbb6791552781a774", "question": "根据 CSCO 2025，对局部晚期（T3–4 或 N2–3）患者，随访理念最符合的是：", "options": {"A": "采用分层管理并强调治疗后 5 年内对高风险患者更密切随访", "B": "随访仅靠血浆 EBV DNA", "C": "只要 1 年无病即可停止随访", "D": "所有患者同一频率随访即可"}, "answer": "A", "choices": ["A. 采用分层管理并强调治疗后 5 年内对高风险患者更密切随访", "B. 随访仅靠血浆 EBV DNA", "C. 只要 1 年无病即可停止随访", "D. 所有患者同一频率随访即可"], "explanation": "CSCO 2025 影像/随访注释明确建议采用分层管理并强调终身随访，对高风险患者前5年更密切。", "source": "CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）；CSCO 2025 §13 随访；表22；NCCN 2025 FOLL-A", "evidence_anchors": ["CSCO 2025 §4.1–4.3（急慢性放疗不良反应、营养支持）", "CSCO 2025 §13 随访；表22", "NCCN 2025 FOLL-A"], "answer_text": "采用分层管理并强调治疗后 5 年内对高风险患者更密切随访", "domain": "诊断、病理与初始评估", "source_type": "Dual-source (CSCO+NCCN)", "scope_major": "VIII. 疗效评估、随访与支持治疗", "scope_minor": "VIII-D. 随访策略与高危人群管理"} |
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